Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Although the diagnosis of pure class V lupus nephritis (LN) is generally thought to portend a favorable prognosis, outcomes on a population-level are not well known. We evaluated the outcomes of those with only class Va/b and class Vc/d disease with a focus of end stage renal disease (ESRD) and death on a population level.Methods: The Georgia Lupus Registry (GLR) is a population-based registry designed to more accurately estimate the incidence and prevalence of systemic lupus erythematosus (SLE) in Atlanta, Georgia, by partnering with the state health department, allowing records to be reviewed without patient consent. Trained abstractors documented demographic and clinical information from potential SLE patients who were prevalent in 2002 and incident in 2002-04. Renal biopsy results (WHO criteria) were obtained from the medical record as well as local and regional commercial nephropathology labs. Those with a concurrent LN class other than V were excluded. Patients were matched to the state death certificate database through 2013 and the United States Renal Data System for ESRD through September 2012.
Results:
Among prevalent patients with class V LN, many resulted in ESRD 35/129 (27.1%) and death 34/129 (26.4%). Among incident patients with class V LN, 3/31 (9.7%) developed ESRD and 6/31 (19.4%) died. There was no significant difference in age, race, ACR criteria manifestations, or outcomes between Va/b and Vc/d in prevalent and incident SLE patients. There were significantly more females with class Vc/d compared to Va/b in prevalent patients. Though not statistically significant in incident patients, more females had class Vc/d compared to Va/b (81.3% vs. 66.7%).Conclusion:
This is the first population-based evaluation of class V only SLE with surveillance for outcomes up to 13 years. Individuals with pure class V LN have relatively high prevalence of ESRD and death with no difference in outcomes between Va/b and Vc/d. Differences in age, race, and ACR manifestations were not seen between the two groups. There were significantly more females with class Vc/d compared to Va/b in prevalent patients. More study is required to understand the factors responsible for poor health outcomes among persons with class V nephritis.|
Prevalent SLE With Class V Only Lupus Nephritis |
||||
|
Characteristic |
Overall (n = 129) |
Class Va/b (n=80) |
Class Vc/d (n=49) |
P Value |
| Age at diagnosis, Mean +/- SD |
28.4 ± 12.2 |
29.9 ± 12.3 |
26.0 ± 11.8 |
0.084 |
| Gender (female), n (%) |
108 (83.7) |
61 (76.3) |
47 (95.9) |
0.0033 |
| Race, n (%) Black |
120 (93.0) |
76 (95.0) |
44 (89.8) |
0.18 |
|
White |
7 (5.4) |
4 (5.0) |
3 (6.1) |
|
|
Other |
2 (1.6) |
– |
2 (4.1) |
|
| Malar rash, n (%) |
45 (34.9) |
25 (31.3) |
20 (40.8) |
0.27 |
| Discord rash, n (%) |
28 (21.7) |
20 (25.0) |
8 (16.3) |
0.25 |
| Photosensitivity, n (%) |
24 (18.6) |
15 (18.8) |
9 (18.4) |
0.96 |
| Oral ulcers, n (%) |
25 (19.4) |
16 (20.0) |
9 (18.4) |
0.82 |
| Arthritis, n (%) |
86 (66.7) |
51 (63.8) |
35 (71.4) |
0.37 |
| Serositis, n (%) |
65 (50.4) |
39 (48.8) |
26 (53.1) |
0.63 |
| Neurologic disorder, n (%) |
24 (18.6) |
11 (13.8) |
13 (26.5) |
0.07 |
| Hematologic disorder, n (%) |
112 (86.8) |
68 (85.0) |
44 (89.8) |
0.43 |
| Immunologic disorder, n (%) |
96 (74.4) |
61 (76.3) |
35 (71.4) |
0.54 |
| ESRD, n (%) |
35 (27.1) |
19 (23.8) |
16 (32.7) |
0.27 |
| Death (by 12/31/2013), n (%) |
34 (26.4) |
20 (25.0) |
14 (28.6) |
0.65 |
| Age at death, Mean +/- SD |
42.3 ± 16.5 |
46.5 ± 17.2 |
36.4 ± 13.8 |
0.079 |
| Median(IQR) |
40.0 (30.7-54.8) |
46.2 (35.7-57.1) |
35.7 (26.1-42.2) |
|
|
Incident SLE With Class V Only Lupus Nephritis |
||||
|
Characteristic |
Overall (n=31) |
Class Va/b (n=15) |
Class Vc/d (n=16) |
P Value |
| Age at diagnosis, Mean +/- SD |
33.2 ± 13.0 |
32.9 ± 12.8 |
33.4 ± 13.6 |
0.92 |
| Gender (female), n (%) |
23 (74.2) |
10 (66.7) |
13 (81.3) |
0.43 |
| Race, n (%) Black |
26 (83.9) |
13 (86.7) |
13 (81.3) |
>0.99 |
|
White |
2 (6.5) |
1 (6.7) |
1 (6.3) |
|
|
Other |
3 (9.7) |
1 (6.7) |
2 (12.5) |
|
| Malar rash, n (%) |
4 (12.9) |
3 (20.0) |
1 (6.3) |
0.33 |
| Discord rash, n (%) |
2 (6.5) |
1 (6.7) |
1 (6.3) |
>0.99 |
| Photosensitivity, n (%) |
2 (6.5) |
2 (13.3) |
|
0.23 |
| Oral ulcers, n (%) |
4 (12.9) |
1 (6.7) |
3 (18.8) |
0.6 |
| Arthritis, n (%) |
13 (41.9) |
6 (40.0) |
7 (43.8) |
>0.99 |
| Serositis, n (%) |
12 (38.7) |
7 (46.7) |
5 (31.3) |
0.47 |
| Neurologic disorder, n (%) |
5 (16.1) |
2 (13.3) |
3 (18.8) |
>0.99 |
| Hematologic disorder, n (%) |
21 (67.7) |
11 (73.3) |
10 (62.5) |
0.7 |
| Immunologic disorder, n (%) |
21 (67.7) |
10 (66.7) |
11 (68.8) |
>0.99 |
| ESRD, n (%) |
3 (9.7) |
2 (13.3) |
1 (6.3) |
0.6 |
| Death (by 12/31/2013), n (%) |
6 (19.4) |
4 (26.7) |
2 (12.5) |
0.32 |
| Age at death, Mean+/- SD |
46.0 ± 9.9 |
47.8 ± 7.8 |
42.3 ± 16.4 |
0.83 |
| Median(IQR) |
49.4 (37.0-53.9) |
49.4 (42.4-53.1) |
42.3 (30.7-53.9) |
|
To cite this abstract in AMA style:
Brandt J, Drenkard C, Cobb J, Bao G, Lim SS. Class V Lupus Nephritis Results in Significant Numbers of End Stage Renal Disease and Death in a Population-Based Registry [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/class-v-lupus-nephritis-results-in-significant-numbers-of-end-stage-renal-disease-and-death-in-a-population-based-registry/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/class-v-lupus-nephritis-results-in-significant-numbers-of-end-stage-renal-disease-and-death-in-a-population-based-registry/