3 Studies Draw Clear Picture of Lupus Nephritis Outcomes

March 4, 2015

Lupus nephritis (LN) flares can arise for 15 years, a newly published longitudinal study shows. Other research reveals predictors of LN outcomes.

Fernandes das Neves M, Irlapati RV, Isenberg D. Assessment of long-term remission in lupus nephritis patients: a retrospective analysis over 30 years.Rheumatology (Oxford). 2015; Feb 27. [Epub ahead of print]

Dall’ Era M, Cisternas M, Smilek D, et al., Predictors of Long-Term Renal Outcome in Lupus Nephritis Trials: Lessons Learned from the Euro-Lupus Nephritis Cohort.Arthritis & Rheumatology. 2015. Published online March 3, 2015. doi: 10.1002/art.39093 

Gómez-Puerta JA, Feldman CH, Alarcón GS, et al., Racial and ethnic differences in mortality and cardiovascular events among patients with end-stage renal disease due to lupus nephritis. Arthritis Care & Research. 2015. Accepted MS. doiI: 10.1002/acr.22562 

These 3 studies, published independently and almost concurrently in different journals, offer a clear picture of the consequences of lupus nephritis (LN).

The bottom line:

•   Flares can continue for up to 15 years.

•   Renal biopsy and perhaps proteinuria levels at 12 months are the best predictors of outcome.

•   Ethnic origin appears to be a factor in outcomes.

The most important predictor of decline in lupus, LN affects up to half of lupus patients and leads to end-stage renal disease in as many as 10% within a decade.

The first report above describes a 30-year study of LN patients. It found that about 16% are blessed with very long-term remission, but some continue to experience flares for as long as 15 years.

The study considers 105 biopsy-proven LN patients managed at University College in London between 1973 and 2008. This revealed less than an 8% incidence of flares between 5 and 15 years after remission, and apparently none after that point.

Among the study group (almost all of them women with a mean age of 24), around 40% achieved remission for 5 consecutive years, defined as normal renal function, no protein in urine, and a 24-hour urine protein level <0.2 g. Remission persisted for 15 years or more for 16.2%.

Comparing those in remission to others with partial or no remission at 5 years, these researchers report that the most significant predictor of remission was renal biopsy meeting World Health Organization (WHO) class IV status.

In this study, chances of long-term remission were not affected by ethnicity or 24-hour proteinuria, or by mean age at lupus diagnosis (age 24), the time between lupus diagnosis and renal disease (a mean of 4.3 years), ethnicity, baseline levels of double-stranded DNA or anticardiolipin (aCL) antibodies, complement, serum creatinine, glomerular filtration rates (GFR), or serum albumin.

In contrast, a multi-national study of clinical trials outcomes (Dall 'Era et al) finds the best predictive marker of LN outcome may be proteinuria levels at 12 months.

Also, researchers at Boston’s Brigham and Women’s Hospital and the University of Alabama at Birmingham (Gómez-Puerta et al) contend that ethnicity does impact lupus nephritis outcomes, with African-Americans having a 27% greater risk of death than Caucasians.

Their study, analyzing data for more than 12,000 patients enrolled in the U.S. Renal Data System between 1995 and2008, finds the best survival rates among Asians. It’s the first study from a non-academic setting to look at outcomes in LN and end-stage kidney disease.