Clinical and histopathological features and short-term outcomes of lupus nephritis: a prospective study of 100 Egyptian patients

• Published in: Lupus 2020-07, Vol.29 (8), p.993-1001
• Main Authors: Saleh, Mohammed, Eltoraby, Ehab E, Tharwat, Samar, Nassar, Mohammed Kamal
• Format: Article
• Language: English
• Subjects: Adult; Biopsy; Comorbidity; Creatinine; Creatinine - blood; Cyclophosphamide; Cyclophosphamide - therapeutic use; Egypt; Female; Hospitals, University; Humans; Hypertension - epidemiology; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Kidney - pathology; Kidneys; Logistic Models; Lupus; Lupus nephritis; Lupus Nephritis - classification; Lupus Nephritis - drug therapy; Lupus Nephritis - physiopathology; Male; Multivariate Analysis; Mycophenolate mofetil; Mycophenolic acid; Mycophenolic Acid - therapeutic use; Nephritis; Patients; Predictive Value of Tests; Prospective Studies; Remission; Remission Induction; Sex Factors; Short term; Treatment Outcome; Young Adult
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203320928424

Objective The short-term outcomes of lupus nephritis (LN) are variable and unpredictable among individuals. We aimed to evaluate the clinical and histopathological features and short-term renal outcomes in LN patients. Methods This was a prospective cohort study carried out at nephrology and rheumatology units in Egypt between 2018 and 2019. A total of 100 patients with biopsy-proven LN were studied. Patients were evaluated for response after six months. Results The female-to-male ratio was 8.1:1. About 70% of patients were hypertensive at disease onset, with rates for classes I, II, III, IV, V and VI LN being 1%, 7%, 20%, 53%, 14% and 6%, respectively. Among the immunosuppressive drugs used for induction, mycophenolate mofetil (MMF) represented the most commonly used (44%) followed by cyclophosphamide (CYC; 37%). After six months of follow-up, about two thirds of patients achieved remission. There was no significant difference in remission rate between MMF and CYC. On multivariate analysis, serum creatinine (SCr) at presentation was the most significant predictor of renal recovery. According to the receiver operating characteristic curve, the cut-off value of SCr was 1.6 mg/dL, with a sensitivity of 76% and specificity of 71% predicting renal recovery. Repeat renal biopsy was needed in 10 patients; class and treatment strategy changed in 40% and 70% of them, respectively. Conclusion Our findings in Egyptian LN patients compare favourably with most studies.