Background/Purpose: Systemic lupus erythematosus (SLE) is an autoimmune disease that usually affects young people. Several reviews have shown that age may have an effect on the clinical expression of the disease and have suggested that in terms of its presentation and clinical course late-onset SLE is generally less severe. Although there is no unanimous agreement, most authors take late onset SLE to refer to disease occurring after age 50. Our objetive was to examine whether advanced age influences the type of histological lesions and prognosis of lupus nephritis.

Methods: The sample comprised 243 patients with SLE treated between 1980 and 2013 at a tertiary university hospital that does not attend pediatric populations. Patients were registered in a specific database. Patients with lupus nephritis confirmed by renal biopsy and follow-up time of at least two years (n = 79) were selected for analysis. Patients were divided into two groups according to age: over 50 (n = 30) and under 50 (n = 49). “Responders” were defined as patients who presented remission (partial or complete) after completing induction therapy, and “non-responders” were patients in whom no improvement was observed in the analytical parameters, those with histological transformation, and those who died of causes related to nephritis.The Student t test was used to compare continuous variables between groups, or the Mann-Whitney test when variables were not normally distributed. To compare qualitative variables the chi-square or Fisher’s exact test was used when the expected frequency was less than 5. The level of significance was set at p < 0.05.

Results: In the 79 patients (64 women), mean age at the time of diagnosis of nephritis was 45 years ± 14 (range 17-80) and mean time since onset of SLE was 15.9 months (range 0 – 456). In 81% (64/79) of cases, renal disease was present at the time of diagnosis or during the first year of follow-up. The mean SLEDAI score was 15 ± 7.6. The main results of the comparative study between age groups are shown in the following table:

	Age ≤ 50 years (N = 49)	Age  > 50 years (N = 30)	p
Sex (male/female) Evolution course of SLE in months (median) Lupus nephritis Class II Lupus nephritis Class III Lupus nephritis Class IV-S Lupus nephritis Class IV-G Lupus nephritis Class V Activity Index (mean ± SD) Chronicity Index  (mean ± SD) Responders / No responders Development of renal insufficiency	11/38 2 (0-230) 7 (14%) 10 (20%) 12 (24.5%) 13 (26.5%) 7 (14%) 7.8 ± 4.5 1.5 ± 1.5 40 (82%)/ 9 (18%) 7 (14.3%)	4/26 1 (0-456) 7 (23%) 4 (13%) 5 (17%) 9 (30%) 5 (17%) 6 ± 4 1.3 ± 1.9 24 (80%)  / 6 (20%) 3 (10%)	0.268 0.504 0.363 0.367 0.349 0.850 0.852 0.151 0.467 0.121 0.114

No significant differences were observed between age groups in either the type of renal injury or prognosis.

With regard to treatment, no differences were observed in the percentage of patients who were given hydroxychloroquine, corticosteroids or immunosuppressants, but the use of statins (p = 0.038) and ACE inhibitors (p = 0.033) was higher in the over 50s group.

Conclusion: Advanced age does not determine the type of histological lesion, nor does it appear to be a poor prognostic factor in lupus nephritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-advanced-age-influence-the-type-of-renal-injury-and-the-prognosis-of-lupus-nephritis/