Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Lupus nephritis (LN) usually develops within the first years of Systemic Lupus Erythematosus (SLE) onset and rarely after that. There are scarce studies comparing early versus late onset nephritis (before vs. five years of diagnosis). In the only two reports available, the lack of renal biopsy and inclusion of elderly patients in one and the non exclusion of concomitant APS and other associated autoimmune diseases in the other preclude a definitive conclusion about their findings. The aim of this study was to compare the severity and long-term outcome (after 7 years) in these two groups: early and late-onset nephritis.
Methods: 77 patients with biopsy-proven LN with more than 7 years of follow-up were included. Patients were divided in two groups: early-onset nephritis (n=62) and late-onset nephritis (n=15). Clinical and laboratorial data were obtained using a standardized electronic chart database protocol carried out at 1-6 months interval and established in 2000. In order to minimize bias, patients >50 years or with concomitant autoimmune diseases were excluded. Variables evaluated at the LN presentation were SLEDAI, creatinine, albumin, anti-DNA positivity and nephritis class. Variables evaluated at the long-term outcome (after 7 years) were SDI, creatinine, dialysis and mortality. T test, Fisher and Mann Whitney were used for comparison.
Results: The average time of LN presentation was 0.9±1.4 years for the early-onset group and 10.6±3.6 years for the late-onset group. Of note, both groups had similar nephritis duration (13.5±4.2 vs. 13.1±2.9 years, p=0.69) and comparable mean ages (30.1±10.5 vs. 35.4±10.0 years, p=0.08) allowing a more accurate comparison between groups. Regarding severity, groups were alike at nephritis onset: SLEDAI (8.5 [min-max.: 4-22] vs. 7[min-max.: 6-17] p=0.14), creatinine (1.49 mg/dl±1.21 vs. 1.48±0.99, p=0.95); albumin (2.59 mg/dl±0.84 vs. 2.84±0.65 p=0.23); proteinuria (5.27 ±4.7 vs. 3.95±2.1 mg/dl, p=0.05); proliferative nephritis (53%[n=33] vs. 40%[n=6] p=0.37). There was also no difference in the long-term outcomes between the groups: SDI (1 [min-max.0 – 5] vs. (1 [min-max.:0 – 4], p=0.73); creatinine (1.93mg/dl±2.4 vs. 2.1±2.6, p=0.34); dialysis (16.1% [n=10] vs. 20.0% [n=3], p=0.70); mortality (14.5% [n=9] vs. 0% [n=0], p=0.19).
Conclusion: On the present study we demonstrated that late-onset nephritis is comparable to early-onset nephritis concerning clinical, laboratorial and histological features at presentation. In addition, we provided novel evidence that long-term outcomes in biopsy proven severe lupus patients without other associated autoimmune diseases are comparable in both groups. These findings suggest that treatment targets and therapeutic interventions should be the same for these patients.
To cite this abstract in AMA style:Lopes M, Santos L, Seguro L, Bonfa E. Early and Late Onset Biopsy Proven Lupus Nephritis without Other Associated Autoimmune Diseases: Severity and Long-Term Outcome [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/early-and-late-onset-biopsy-proven-lupus-nephritis-without-other-associated-autoimmune-diseases-severity-and-long-term-outcome/. Accessed August 13, 2020.
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