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The frequency and outcome of lupus nephritis: results from an international inception cohort study.

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Authors
Hanly, John G
O'Keeffe, Aidan G
Su, Li
Urowitz, Murray B
Romero-Diaz, Juanita
Gordon, Caroline
Bae, Sang-Cheol
Bernatsky, Sasha
Clarke, Ann E
Wallace, Daniel J
Merrill, Joan T
Isenberg, David A
Rahman, Anisur
Ginzler, Ellen M
Fortin, Paul
Gladman, Dafna D
Sanchez-Guerrero, Jorge
Petri, Michelle
Bruce, Ian N
Dooley, Mary Anne
Ramsey-Goldman, Rosalind
Aranow, Cynthia
Alarcón, Graciela S
Fessler, Barri J
Steinsson, Kristjan
Nived, Ola
Sturfelt, Gunnar K
Manzi, Susan
Khamashta, Munther A
van Vollenhoven, Ronald F
Zoma, Asad A
Ramos-Casals, Manuel
Ruiz-Irastorza, Guillermo
Lim, S Sam
Stoll, Thomas
Inanc, Murat
Kalunian, Kenneth C
Kamen, Diane L
Maddison, Peter
Peschken, Christine A
Jacobsen, Soren
Askanase, Anca
Theriault, Chris
Thompson, Kara
Farewell, Vernon
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Issue Date
2016-02

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Citation
Rheumatology (Oxford) 2016, 55 (2):252-62
Abstract
To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort.
Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores.
There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values.
LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.
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Additional Links
http://dx.doi.org/ 10.1093/rheumatology/kev311
http://rheumatology.oxfordjournals.org/content/55/2/252.full.pdf
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Archived with thanks to Rheumatology (Oxford, England)
ae974a485f413a2113503eed53cd6c53
10.1093/rheumatology/kev311
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English Journal Articles (Peer Reviewed)

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