Background/Purpose:  In African-descent patients, lupus nephritis (LN) lead to a worse outcome than in Caucasians. Long term data are rare in countries where black populations have access to free healthcare. Here, we describe the long term prognosis of black Martinican patients with LN.

Methods:   Population based, retrospective consultation of 1140 kidney biopsy provided by the pathology unit of the academic hospital of Martinique (French West Indies) from 2002 to 2015. 155 biopsies were related to SLE, concerning 126 patients. All patients diagnosed before 2013, followed a minimum of 24 month in Martinique (or death) after biopsy proven LN (ISN/RPS classification) were included. Complete remission (CR) was defined by no GFR decrease > 10%, no leucocyturia/hematuria and proteinuria ≤ 0.2 g/24h. Partial remission (PR) had the same definition except for proteinuria ≤ 0.5 g/24h. Renal flare flare was defined by an increase >1g/24h of proteinuria if CR, >2g/24h if PR, or a persistent increase >25% of creatinemia. Chronic renal failure (CRF) was defined by GFR<90ml/min/1.72m² (normal if above) and end stage renal disease (ESRD) by requiring chronic dialysis.

Results:   89 patients were included (women 93.3%), and 37 excluded. Mean (±SD) follow up times was 118.3 months (± 73.3). No patient was lost to follow-up. Median age at SLE diagnosis was 27 yo and 30 for LN. The initial mean proteinuria was 3.55g/d (range 0.6 to 27) and creatinemia 118.9 µmol/L (range 26 to 500). Eighteen percent (n=16) had antiphospholipid syndrome. LN was proliferative in 68/89 patients (76.4%): 17 were class III (19.1%), 22 class IV (24.7%), 18 class III+V (20.2%), 11 class IV+V (12.4%). 17 patients were Class V (19.1%), 3 class I (3.4%) and 1 class II (1.1%). Concerning proliferative LN, induction treatment was cyclophosphamide (CYC), mycophenolate mofetil (MMF) and azathioprine (AZA) in respectively 66.1%, 25%, 4.4%. MMF was used as maintenance treatment for 51 patients (75%), CYC and AZA for 5.9% each. All patients received steroids and 91% hydroxychloroquine. At one year, 65/89 had normal GFR (73%), 33 attain CR (37.1%), 9 PR (10.11%), 15 progress to CRF (16.8%), none to ESRD and 3 died (3.3%). During follow up, 23 patients experienced only one renal flare (26.1%), 8 two flares (9.1%) and 1 three flares (1.1%). 68 new biopsies were performed: in 13, class V (76.5%) turn into proliferative LN after a mean delay of 90.2 months. After a mean follow up of 118.4 months: 39/89 (43.8%) achieve CR, 7 (7.9%) PR, 20 (22.4%) progress to CRF, 14 (15.7%) to ESRD and 8 (9%) died. ESRD rates for all 89 patients were respectively at 5, 10 and 15 years : 4.29%, 19,57% and 46.8%. Mortality rates for all 89 patients were 5.7% at 5 years, 8.7% at 10, 12.5% at 15, and for proliferative LN patients respectively 7.5%, 12.9%, 17.4%.

Conclusion:  Compared to other population based Afro-Caribbean study finding a 31 to 41% mortality rate at 5 years (Nossent et al., ARD 1993; Flower et al, Arthritis Care Res 2012), our data suggest a better prognosis mainly related in our opinion to free access to Healthcare.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-prognosis-of-lupus-nephritis-in-the-afro-caribbean-population-of-martinique-with-free-access-to-healthcare/