Lupus nephritis among 624 cases of systemic lupus erythematosus in Riyadh, Saudi Arabia |
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Authors: | Abdurahman Saud Al Arfaj Najma Khalil Salman Al Saleh |
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Institution: | (1) Department of Medicine, College of Medicine, King Saud University, P.O. Box 34471, Riyadh, 11468, Saudi Arabia;(2) King Faisal Specialist Hospital, Riyadh, Saudi Arabia |
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Abstract: | The aim of this article is to study the prevalence, clinicolaboratory features, WHO histological types, therapy and renal
outcome of lupus nephritis (LN) in Saudi Arabia. During the 27-year-period (1980–2006), 299 (47.9%) cases of LN were identified
among the 624 cases of systemic lupus erythematosus (SLE) follow-up at King Khalid University Hospital, Riyadh. The female:male
ratio in LN was 8.3:1, with a mean age of 32 years and a mean age of onset of 23 years. The WHO renal histological types were;
Class I (1%), Class II (18.1%), Class III (10%), Class IV (37.1%), Class V (11.7%), and Class VI (2.7%). Azathioprine was
given to 43.1% and pulse cyclophosphamide to 65.6% in combination with other drugs. Remission was seen in 226 (75.6%) patients,
renal flares in 14 (4.7%), end stage renal disease (ESRD) in 27 (9.0%), death in 18 (6.0%), and 14 (4.7%) lost follow-up.
The 5- and 10-year patient survival rates in our whole LN cohort by Kaplan–Meier analysis were 96% and 95%, respectively.
The survival did not differ significantly in different LN classes nor did it differ significantly during the three periods
of presentation (1980–1990, 1991–2000, and 2001–2006; P > 0.05). The risk factors for poor survival were found to be older age at onset (>50-years age; P = 0.034), ESRD (P = 0.000), and low C3 (P = 0.022). The risk factors for progression to ESRD were older age at onset (>50-years age; P = 0.037), hypertension (P = 0.009), elevated serum creatinine (P = 0.000), and proliferative LN (Classes III, IV; P = 0.013, P = 0.039). Different treatment modalities did not have significant effect on survival in the whole LN cohort (P = >0.05). However, pulse cyclophosphamide favored remission in Classes II, III, IV, and V (P = 0.023). The main causes of death were renal failure (50%) and infections (44.4%). |
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Keywords: | Lupus nephritis Prevalence Saudi Arabia Systemic lupus erythematosus Renal outcome WHO nephritis class |
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