Clinical Reviews in Allergy & Immunology

, Volume 40, Issue 3, pp 199–207 | Cite as

Lupus Nephritis in Colombians: Contrasts and Comparisons with Other Populations

  • Juan-Manuel Anaya
  • Carlos Cañas
  • Rubén D. Mantilla
  • Ricardo Pineda-Tamayo
  • Gabriel J. Tobón
  • Catalina Herrera-Diaz
  • Diego M. Rendón
  • Adriana Rojas-Villarraga
  • Mauricio Uribe


Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus (SLE) since it is the major predictor of poor prognosis. The purpose of this study was to examine the clinical and immunological characteristics associated with LN development during the course of SLE in Colombians. Therefore, patients with SLE followed at five different referral centers in Medellin, Bogota, and Cali were included in this cross-sectional and multicenter study. Factors influencing LN were assessed by conditional logistic regression analysis, adjusting by gender, age at onset, duration of disease, and city of origin. The entire sample population included 467 patients, of whom 51% presented with LN. The presence of anti-dsDNA antibodies (adjusted odds ratio (AOR), 2.06; 95% confidence interval (CI), 1.16–3.65), pleuritis (AOR, 3.82; 95% CI, 1.38–10.54), and hypertension (AOR, 2.63; 95% CI, 1.23–5.62) were positively associated with LN, whereas the presence of anti-La antibodies was a protective factor against LN development (AOR, 0.4; 95% CI, 0.19–0.85). A review of literature on LN in different populations is made. The identified clinical- and laboratory-associated factors would assist earlier diagnosis and guide decisions on therapeutic interventions on this critical and frequent complication of SLE.


Systemic lupus erythematosus Lupus nephritis Anti-La antibodies Hypertension Colombia 



We thank all participants in this study as well as Oscar-Danilo Ortega-Hernández for his assistance. This work was supported by the School of Medicine and Health Sciences, Universidad del Rosario, and an unrestricted grant from LAFRANCOL S.A., Bogota, Colombia.

Conflicts of Interest

The authors declare no conflicts of interest.


  1. 1.
    Borchers AT, Naguwa SM, Shoenfeld Y, Gershwin ME (2010) The geoepidemiology of systemic lupus erythematosus. Autoimmun Rev 9:A277–A287PubMedCrossRefGoogle Scholar
  2. 2.
    Font J, Cervera R, Ramos-Casals M, García-Carrasco M, Sents J, Herrero C et al (2004) Clusters of clinical and immunologic features in systemic lupus erythematosus: analysis of 600 patients from a single center. Semin Arthritis Rheum 33:217–230PubMedCrossRefGoogle Scholar
  3. 3.
    Jiménez S, Cervera R, Font J, Ingelmo M (2003) The epidemiology of systemic lupus erythematosus. Clin Rev Allergy Immunol 25:3–12PubMedCrossRefGoogle Scholar
  4. 4.
    Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH et al (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 41:778–799PubMedCrossRefGoogle Scholar
  5. 5.
    Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P et al (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. Med (Baltimore) 82:299–308CrossRefGoogle Scholar
  6. 6.
    Mak A, Mok CC, Chu WP, To CH, Wong SN, Au TC (2007) Renal damage in systemic lupus erythematosus: a comparative analysis of different age groups. Lupus 16:28–34PubMedCrossRefGoogle Scholar
  7. 7.
    Urowitz MB, Ibañez D, Ali Y, Gladman DD (2007) Outcomes in patients with active lupus nephritis requiring immunosuppressives who never received cyclophosphamide. J Rheumatol 34:1491–1496PubMedGoogle Scholar
  8. 8.
    Huong DL, Papo T, Beaufils H, Wechsler B, Blétry O, Baumelou A et al (1999) Renal involvement in systemic lupus erythematosus. A study of 180 patients from a single center. Med (Baltimore) 78:148–166CrossRefGoogle Scholar
  9. 9.
    Bastian HM, Roseman JM, McGwin G Jr, Alarcón GS, Friedman AW, Fessler BJ et al (2002) Systemic lupus erythematosus in three ethnic groups XII. Risk factors for lupus nephritis after diagnosis. Lupus 11:152–160PubMedCrossRefGoogle Scholar
  10. 10.
    Yung S, Chan TM (2007) Anti-DNA antibodies in the pathogenesis of lupus nephritis—the emerging mechanisms. Autoimmun Rev 7:317–321PubMedCrossRefGoogle Scholar
  11. 11.
    Alarcón GS, Friedman AW, Straaton KV, Moulds JM, Lisse J, Bastian HM et al (1999) Systemic lupus erythematosus in three ethnic groups: III. A comparison of characteristics early in the natural history of the LUMINA cohort. Lupus in minority populations: nature vs. nurture. Lupus 8:197–209PubMedCrossRefGoogle Scholar
  12. 12.
    Pons-Estel BA, Catoggio LJ, Cardiel MH, Soriano ER, Gentiletti S, Villa AR et al (2004) The GLADEL multinational Latin American prospective inception cohort of 1, 214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among "Hispanics". Med (Baltimore) 83:1–17CrossRefGoogle Scholar
  13. 13.
    Hochberg MC (1997) Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725PubMedCrossRefGoogle Scholar
  14. 14.
    Petri M (2000) Hopkins lupus cohort. 1999 update. Rheum Dis Clin North Am 26:199–213PubMedCrossRefGoogle Scholar
  15. 15.
    Molina JF, Molina J, García C, Gharavi AE, Wilson WA, Espinoza LR (1997) Ethnic differences in the clinical expression of systemic lupus erythematosus: a comparative study between African-Americans and Latin Americans. Lupus 6:63–67PubMedCrossRefGoogle Scholar
  16. 16.
    Pinto LF, Guerra L, González JR (1997) Lupus eritematoso sistémico. análisis del comportamiento clínico en una población de Medellín. Rev Colomb Reumatol 4:170–173Google Scholar
  17. 17.
    Pinto LF, Senior JM (1993) Nefropatía lúpica: Correlación clínico-patológica y respuesta a pulsos de ciclofosfamida. Acta Med Colomb 18:157–163Google Scholar
  18. 18.
    Pinto LF, Hernandez GE, Robledo CG (1995) Asociación de los anti-ENAS con la Clínica en 85 Pacientes con LES (Abstract). Rev Colomb Reumatol 2:65Google Scholar
  19. 19.
    Malik S, Bruner GR, Williams-Weese C, Feo L, Scofield RH, Reichlin M et al (2007) Presence of anti-La autoantibody is associated with a lower risk of nephritis and seizures in lupus patients. Lupus 16:863–866PubMedCrossRefGoogle Scholar
  20. 20.
    Skare TL, Silva MB, Holler AP, Chavez PA (2009) Protective role of rheumatoid factor in lupus nephritis. Clin Exp Rheumatol 27:895PubMedGoogle Scholar
  21. 21.
    Fattal I, Shental N, Mevorach D, Anaya JM, Livneh A, Langevitz P et al (2010) An antibody profile of systemic lupus erythematosus detected by antigen microarray. Immunology 130:337–343Google Scholar
  22. 22.
    Anaya JM, Uribe M, Pérez A, Sanchez LF, Pinto LF, Molina JF et al (2003) Clinical and immunological factors associated with lupus nephritis in patients from Northwestern Colombia. Biomedica 23:293–300PubMedGoogle Scholar
  23. 23.
    Ravirajan CT, Rowse L, Macgowan JR, Isenberg DA (2001) An analysis of clinical disease activity and nephritis-associated serum autoantibody profiles in patients with systemic lupus erythematosus: a cross-sectional study. Rheumatology 40:1405–1412PubMedCrossRefGoogle Scholar
  24. 24.
    Kramers C, Termatt R, Ter Borg EJ, Van Bruggen MC, Kallenberg CG, Berden JH (1993) Higher anti-heparan sulphate reactivity during systemic lupus erythematosus (SLE) disease exacerbations with renal manifestations: a long term prospective analysis. Clin Exp Immunol 93:34–38PubMedCrossRefGoogle Scholar
  25. 25.
    Arbuckle MR, James JA, Kohlhase KF, Rubertone MV, Dennis GJ, Harley JB (2001) Development of anti-dsDNA autoantibodies prior to clinical diagnosis of systemic lupus erythematosus. Scand J Immunol 54:211–219PubMedCrossRefGoogle Scholar
  26. 26.
    Boumpas DT, Fessler BJ, Austin HA 3rd, Balow JE, Klippel JH, Lockshin MD (1995) Systemic lupus erythematosus: emerging concepts. part 2: dermatologic and joint disease, the antiphospholipid antibody syndrome, pregnancy and hormonal therapy, morbidity and mortality, and pathogenesis. Ann Intern Med 123:42–53PubMedGoogle Scholar
  27. 27.
    Gavalchin J, Seder RA, Datta DK (1987) The NZB X SWR model of lupus nephritis. I. Cross-reactive idiotypes of monoclonal anti-dna antibodies in relation to antigenic specificity, charge, and allotype. Identification of interconnected idiotype families inherited from the normal SWR and the autoimmune NZB parents. J Immunol 138:128–137PubMedGoogle Scholar
  28. 28.
    Ebling F, Hahn BH (1980) Restricted subpopulations of DNA antibodies in kidneys of mice with systemic lupus. Comparison of antibodies in serum and renal eluates. Arthritis Rheum 23:392–403PubMedCrossRefGoogle Scholar
  29. 29.
    Font J, Ramos-Casals M, Cervera R, García-Carrasco M, Torras A, Sisó A et al (2001) Cardiovascular risk factors and the long-term outcome of lupus nephritis. QJM 94:19–26PubMedCrossRefGoogle Scholar
  30. 30.
    Naiker IP (1997) The significance of arterial hypertension at the onset of clinical lupus nephritis. Postgrad Med J 73:230–233PubMedCrossRefGoogle Scholar
  31. 31.
    Donadio JV Jr, Hart GM, Bergstralh EJ, Holley KE (1995) Prognostic determinants in lupus nephritis: a long-term clinicopathologic study. Lupus 4:109–115PubMedCrossRefGoogle Scholar
  32. 32.
    Varela DC, Quintana G, Somers EC, Rojas-Villarraga A, Espinosa G, Hincapie ME et al (2008) Delayed lupus nephritis. Ann Rheum Dis 67:1044–1046PubMedCrossRefGoogle Scholar
  33. 33.
    Cerón CE, Molina J, Zambrano F (1989) Nefropatía Lúpica: Estudio de 156 Casos. Iatreia 2:213–221Google Scholar
  34. 34.
    Gamba G, Quintanilla L, Del Bosque MD, Chew-Wong A, Correa-Rotter R (2000) Evolución y factores pronósticos de la nefropatía lúpica. Rev Invest Clin 52:397–405PubMedGoogle Scholar
  35. 35.
    Zabaleta-Lanz M, Vargas-Arenas RE, Tápanes F, Daboin I, Atahualpa-Pinto J et al (2003) Silent nephritis in systemic lupus erythematosus. Lupus 12:26–30PubMedCrossRefGoogle Scholar
  36. 36.
    Carvalho MF, Soares V (2000) A Glomerulonefrite Lúpica: estudo da evolução a longo prazo. Rev Assoc Méd Bras 46:121–125PubMedCrossRefGoogle Scholar
  37. 37.
    Morales JV, Veronese FJ, Weber R, Klampt CL, Berdichewisk R (2000) Tratamento da nefropatia lúpica severa: efeito da ciclofosfamida endovenosa prolongada intermitente/treatment of severe lupus nephritis: effect of prolonged and intermittent intravenous cyclophosphamide. Rev Hcpa Fac Med Univ Fed Rio Gd Sul 20:220–230Google Scholar
  38. 38.
    Larocca T, Holler AP, Chaves P (2009) Associação entre anticorpos antifosfolípides e fator reumatóide em pacientes com nefrite lúpica: um estudo de 187 Casos. Arquiv Catarinenses Med 38:46–51Google Scholar
  39. 39.
    Williams W, Dipak S, Sargeant LA (2004) The clinical and epidemiologic features in 140 patients with lupus nephritis in a predominantly black population from one center in Kingston, Jamaica. Am J Med Sci 327:324–329PubMedCrossRefGoogle Scholar
  40. 40.
    Espinosa DM, Yrabién FJ, Benítez MC, Alvarez CZ, Estrada EL (2000) Rev Cubana Pediatr 72:112–119Google Scholar
  41. 41.
    Rodríguez R, Finalés E, Rivero T et al. (2003) Nefropatía Lúpica: caracterización durante un quinquenio/Lupic Nephropathy: characterization during a quinquenium. Arch Méd Camaguey 7(3)Google Scholar
  42. 42.
    Flower C, Hennis A, Hambleton IR, Nicholson G (2006) Lupus nephritis in an Afro-Caribbean population: renal indices and clinical outcomes. Lupus 15:689–694PubMedCrossRefGoogle Scholar
  43. 43.
    Seligman VA, Lum RF, Olson JL, Li H, Criswell LA (2002) Demographic differences in the development of lupus nephritis: a retrospective analysis. Am J Med 112:726–729PubMedCrossRefGoogle Scholar
  44. 44.
    Mac Gowan JR, Ellis S, Griffiths M, Isenberg DA (2002) Retrospective analysis of outcome in a cohort of patients with lupus nephritis treated between 1977 and 1999. Rheumatology 41:981–987CrossRefGoogle Scholar
  45. 45.
    Moss KE, Isenberg DA (2001) Comparison of renal disease severity and outcome in patients with primary antiphospholipid syndrome, antiphospholipid secondary to systemic lupus erythematosus (SLE) and SLE alone. Rheumatology 40:863–867PubMedCrossRefGoogle Scholar
  46. 46.
    Alba P, Bento L, Cuadrado MJ, Karim Y, Tungekar MF, Abbs L et al (2003) Anti-dsDNA, anti-Sm antibodies, and the lupus anticoagulant: significant factors associated with lupus nephritis. Ann Rheum Dis 62:556–560PubMedCrossRefGoogle Scholar
  47. 47.
    Gallego N (1999) Grupo de estudio de la nefropatía lúpica infantil Nefropatía lúpica en la infancia: estudio multicéntrico. Nefrologia 19:327–330Google Scholar
  48. 48.
    Cortés J, Ordi-Ros J, Labrador M, Segundo B, Balada E, Segarra A et al (2004) Antihistone and anti-double-stranded deoxyribonucleic acid antibodies are associated with renal disease in systemic lupus erythematosus. Am J Med 116:165–173CrossRefGoogle Scholar
  49. 49.
    Huong LT, Du P, Thomas B et al (1999) Renal involvement in systemic lupus erythematosus: a study of 180 patients from a single center. Medicine 78:148–166PubMedCrossRefGoogle Scholar
  50. 50.
    Gan HC, Hyoon K, Fong KY (2002) Clinical outcomes of patients with biopsy-proven lupus nephritis in NUH. Singapore Med J 43:614–616PubMedGoogle Scholar
  51. 51.
    Takayuki K, Ken Y, Kaoru S, Michihiro O, Kazuo K, Hitoshi O et al (2010) Investigation of pathological and clinical features of lupus nephritis in 73 autopsied cases with systemic lupus erythematosus. Mod Rheumatol 20:168–177CrossRefGoogle Scholar
  52. 52.
    Abdurahman SA, Najma K, Salman S (2009) Lupus nephritis among 624 Cases of systemic lupus erythematosus in Riyadh Saudi Arabia. Rheumatol Int 29:1057–1067CrossRefGoogle Scholar
  53. 53.
    Attia HM (2000) Lupus nephritis among Arabs—differences with other races; emphasis on clinicopathological and serological perspectives. Saudi J Kidney Dis Transpl 11:370–380PubMedGoogle Scholar
  54. 54.
    Uthman IW, Muffarij AA, Mudawar WA, Nasr FW, Masri AF (2001) Lupus nephritis in Lebanon. Lupus 10:378–381PubMedCrossRefGoogle Scholar
  55. 55.
    Burling F1, Ng J, Thein H, Ly J, Marshall MR, Gow (2007) Ethnic, clinical and immunological factors in systemic lupus erythematosus and the development of lupus nephritis: results from a multi-ethnic New Zealand cohort. Lupus 16:830–837PubMedCrossRefGoogle Scholar
  56. 56.
    Niang A, Dia D, Pouye A, Kane A, Dieng MT, Ka MM et al (2008) Lupus nephritis in Senegal: a study of 42 cases. Saudi J Kidney Dis Transpl 19:470–474PubMedGoogle Scholar
  57. 57.
    Houman MH, Smiti-Khanfir M, Ben Ghorbell I, Miled M (2004) Systemic lupus erythematosus in Tunisia: demographic and clinical analysis of 100 patients. Lupus 13:204–211PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Juan-Manuel Anaya
    • 1
  • Carlos Cañas
    • 2
  • Rubén D. Mantilla
    • 1
    • 3
  • Ricardo Pineda-Tamayo
    • 1
    • 4
  • Gabriel J. Tobón
    • 2
  • Catalina Herrera-Diaz
    • 1
  • Diego M. Rendón
    • 1
  • Adriana Rojas-Villarraga
    • 1
    • 3
  • Mauricio Uribe
    • 5
  1. 1.Center for Autoimmune Diseases Research (CREA), School of Medicine and Health SciencesUniversidad del RosarioBogotaColombia
  2. 2.Rheumatology UnitFundación Clínica Valle de LiliCaliColombia
  3. 3.Rheumatology UnitRiesgo de Fractura-CAYRE IPSBogotaColombia
  4. 4.ART-Medica IPSMedellinColombia
  5. 5.Clínica Universitaria BolivarianaMedellinColombia

Personalised recommendations