Lupus nephritis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2] Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S. [3]

Overview

Common complications of Lupus nephritis include microscopic hematuria, nephrotic syndrome, celluar casts, elevated creatnine and destruction of more than 50% of glomeruli.

Natural History, Complications, and Prognosis

Natural History

Lupus nephritis may damage different parts of the kidney. Class I has normal histology and does not show any evidence of disease and class V shows an extensive disease.

The symptoms of Lupus nephritis usually develop in one half of the patients with SLE and start with symptoms such as proteinuria.^[1]^[2]^[3]
The symptoms of Lupus nephritis typically develop within three years after having SLE.^[3]^[4]^[5]
If left untreated, thirty percent of patients with SLE may progress to develop hematuria, nephrotic syndrome, and hypertension.

Complications

Possible complications include:^[3]

Prognosis

The class of lupus nephritis: Focal lupus nephritis, minimal mesangial lupus nephritis and mesangial proliferative lupus nephritis have better prognosis than other classes. And, advanced sclerosis lupus nephritis carries a poor prognosis.^[4]
Nephrotic syndrome carries worse prognosis.^[5]
Creatinine level: Patients with elevated creatinine (>3 mg/dL) at presentation have worse outcomes.^[5]
Patients with persistently elevated anti-dsDNA and low C3 and C4 levels have poorer outcomes.
Renal biopsy findings showing diffuse lupus nephritis or high chronicity index suggest worse prognosis.^[5]^[4]
Young age onset carries worse prognosis.
Male gender have poorer outcomes than female.^[4]
Black race have worse outcomes than other races.^[4]
Although lupus nephritis may return in a transplanted kidney, it rarely leads to end-stage kidney disease.^[5]

Prognosis is generally poor for class IV, and the 50% survival is 15/+- 2.5 years.^[6]^[7]

References

↑ Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Doménech I, Aydintug AO, Jedryka-Góral A, de Ramón E (March 1993). “Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus”. Medicine (Baltimore). 72 (2): 113–24. PMID 8479324.
↑ Seligman VA, Lum RF, Olson JL, Li H, Criswell LA (June 2002). “Demographic differences in the development of lupus nephritis: a retrospective analysis”. Am. J. Med. 112 (9): 726–9. PMID 12079714.
↑ ^3.0 ^3.1 ^3.2 Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR (September 2003). “Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients”. Medicine (Baltimore). 82 (5): 299–308. doi:10.1097/01.md.0000091181.93122.55. PMID 14530779.
↑ ^4.0 ^4.1 ^4.2 ^4.3 ^4.4 Almaani S, Meara A, Rovin BH (May 2017). “Update on Lupus Nephritis”. Clin J Am Soc Nephrol. 12 (5): 825–835. doi:10.2215/CJN.05780616. PMC 5477208. PMID 27821390.
↑ ^5.0 ^5.1 ^5.2 ^5.3 ^5.4 ^5.5 Alarcón GS (2011). “Multiethnic lupus cohorts: what have they taught us?”. Reumatol Clin. 7 (1): 3–6. doi:10.1016/j.reuma.2010.11.001. PMID 21794772.
↑ Kashgarian M (March 1994). “Lupus nephritis: lessons from the path lab”. Kidney Int. 45 (3): 928–38. PMID 8196299.
↑ Yokoyama H, Wada T, Hara A, Yamahana J, Nakaya I, Kobayashi M, Kitagawa K, Kokubo S, Iwata Y, Yoshimoto K, Shimizu K, Sakai N, Furuichi K (December 2004). “The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese”. Kidney Int. 66 (6): 2382–8. doi:10.1111/j.1523-1755.2004.66027.x. PMID 15569330.

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[pmid8479324-1] Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Doménech I, Aydintug AO, Jedryka-Góral A, de Ramón E (March 1993). “Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus”. Medicine (Baltimore). 72 (2): 113–24. PMID 8479324.

[pmid12079714-2] Seligman VA, Lum RF, Olson JL, Li H, Criswell LA (June 2002). “Demographic differences in the development of lupus nephritis: a retrospective analysis”. Am. J. Med. 112 (9): 726–9. PMID 12079714.

[pmid145307792-3] 3.0 ^3.1 ^3.2 Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR (September 2003). “Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients”. Medicine (Baltimore). 82 (5): 299–308. doi:10.1097/01.md.0000091181.93122.55. PMID 14530779.

[pmid27821390-4] 4.0 ^4.1 ^4.2 ^4.3 ^4.4 Almaani S, Meara A, Rovin BH (May 2017). “Update on Lupus Nephritis”. Clin J Am Soc Nephrol. 12 (5): 825–835. doi:10.2215/CJN.05780616. PMC 5477208. PMID 27821390.

[pmid21794772-5] 5.0 ^5.1 ^5.2 ^5.3 ^5.4 ^5.5 Alarcón GS (2011). “Multiethnic lupus cohorts: what have they taught us?”. Reumatol Clin. 7 (1): 3–6. doi:10.1016/j.reuma.2010.11.001. PMID 21794772.

[pmid8196299-6] Kashgarian M (March 1994). “Lupus nephritis: lessons from the path lab”. Kidney Int. 45 (3): 928–38. PMID 8196299.

[pmid15569330-7] Yokoyama H, Wada T, Hara A, Yamahana J, Nakaya I, Kobayashi M, Kitagawa K, Kokubo S, Iwata Y, Yoshimoto K, Shimizu K, Sakai N, Furuichi K (December 2004). “The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese”. Kidney Int. 66 (6): 2382–8. doi:10.1111/j.1523-1755.2004.66027.x. PMID 15569330.

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