Rheumatology International

, Volume 30, Issue 10, pp 1311–1315 | Cite as

Male gender results in more severe lupus nephritis

  • Jozélio Freire de Carvalho
  • Ana Patrícia do Nascimento
  • Leonardo A. Testagrossa
  • Rui Toledo Barros
  • Eloísa Bonfá
Original Article

Abstract

Gender may produce different characteristics in the manifestation of systemic lupus erythematosus (SLE). The present study investigated the influence of gender on clinical, laboratory, autoantibodies and histopathological classes of lupus nephritis (LN). As much as 81 patients diagnosed with SLE (ACR criteria) and active nephritis, who underwent renal biopsy between 1999 and 2004, and who had frozen serum samples and clinical data available from the time of biopsy, were selected for this study. The presence of anti-P and antichromatin antibodies was measured using ELISA, and anti-dsDNA was measured using indirect immunofluorescence. All of the renal biopsies were reviewed in a blinded manner by the same expert renal pathologist. The charts were extensively reviewed for demographic and renal features obtained at the time of the biopsy. Of the 81 patients (13.6%), 11 were male SLE patients. Both male and female lupus patients were of similar age and race, and had similar durations of lupus and renal disease. The female patients had more cutaneous (95.7 vs. 45.5%, P = 0.0001) and haematological (52.9 vs. 18.2%, P = 0.04) involvements than the male SLE patients. In addition, the articular data, central nervous system analyses, serositis findings and SLEDAI scores were similar in both experimental groups. Positivity for anti-dsDNA, anti-ribosomal P and antichromatin did not differ between the two groups, and both groups showed similarly low C3 or C4 serum levels. Our analysis indicated that no histopathological class of LN was predominant in both males and females. Interestingly, the serum creatinine levels were higher in the male SLE patients compared to the female SLE group (3.16 ± 2.49 vs. 1.99 ± 1.54 mg/dL, P = 0.03), with an increased frequency of high creatinine (81.8 vs. 47.1%, P = 0.04) as well as renal activity index (7.6 ± 3.5 vs. 4.8 ± 3.5, P = 0.02). In addition, whilst the mean levels of proteinuria, cylindruria and serum albumin were markedly altered, they were comparable between both lupus men and women. Moreover, the frequencies of dialysis, renal transplantation and death were similar between the two groups. These data suggest that male patients had a more severe LN compared to women diagnosed with this renal abnormality.

Keywords

Systemic lupus erythematosus Lupus nephritis Gender Prognosis Autoantibodies Kidney involvement 

References

  1. 1.
    Zandman-Goddard G, Peeva E, Shoenfeld Y (2007) Gender and autoimmunity. Autoimmun Rev 6:366–372CrossRefPubMedGoogle Scholar
  2. 2.
    Martins L, Rocha G, Rodrigues A et al (2002) Lupus nephritis: a retrospective review of 78 cases from a single center. Clin Nephrol 57:114–119PubMedGoogle Scholar
  3. 3.
    Arbuckle MR, James JA, Dennis GJ et al (2003) Rapid clinical progression to diagnosis among African-American men with systemic lupus erythematosus. Lupus 12:99–106CrossRefPubMedGoogle Scholar
  4. 4.
    Wang F, Wang CL, Tan CT, Manivasagar M (1997) Systemic lupus erythematosus in Malaysia: a study of 539 patients and comparison of prevalence and disease expression in different racial and gender groups. Lupus 6:248–253CrossRefPubMedGoogle Scholar
  5. 5.
    Soni SS, Gowrishankar S, Adikey GK, Raman A (2008) Sex-based differences in lupus nephritis: a study of 235 Indian patients. J Nephrol 21:570–575PubMedGoogle Scholar
  6. 6.
    Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:17CrossRefGoogle Scholar
  7. 7.
    Weening JJ, D’Agati VD, Schwartz MM et al (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 65:521–530CrossRefPubMedGoogle Scholar
  8. 8.
    Bombardier C, Gladman DD, Urowitz MB, Caron D et al (1992) Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 35:630–640CrossRefPubMedGoogle Scholar
  9. 9.
    Aarden LA, de Groot ER, Feltkamp TE (1975) Immunology of DNA III. Crithidia luciliae, a simple substrate for the determination of anti-dsDNA with the immunofluorescence technique. Ann N Y Acad Sci 254:505–515CrossRefPubMedGoogle Scholar
  10. 10.
    Carvalho JF, Viana VS, Borba EF et al (2008) High-titer antichromatin antibody is associated with proliferative class IV of lupus nephritis. Clin Rheumatol 27:1417–1421CrossRefPubMedGoogle Scholar
  11. 11.
    Magsaam J, Gharavi AE, Parnassa AP, Weissbach H, Brot N, Elkon KB (1989) Quantification of lupus anti-ribosome P antibodies using a recombinant P2 fusion protein and determination of the predicted amino acid sequence of the autoantigen in patients’ mononuclear cells. Clin Exp Immunol 76:165–171PubMedGoogle Scholar
  12. 12.
    Bonfa E, Golombek SJ, Kaufman LD et al (1987) Association between lupus psychosis and anti-ribosomal P protein antibodies. N Engl J Med 317:265–271PubMedGoogle Scholar
  13. 13.
    Waldman M, Madaio MP (2005) Pathogenic autoantibodies in lupus nephritis. Lupus 14:19–24CrossRefPubMedGoogle Scholar
  14. 14.
    Mannik M, Merrill CE, Stamps LD, Wener MH (2003) Multiple autoantibodies form the glomerular immune deposits in patients with systemic lupus erythematosus. J Rheumatol 30:1495–1504PubMedGoogle Scholar
  15. 15.
    Foster MH, Cizman B, Madaio MP (1993) Nephritogenic autoantibodies in systemic lupus erythematosus: immunochemical properties, mechanisms of immune deposition, and genetic origins. Lab Invest 69:494–507PubMedGoogle Scholar
  16. 16.
    Cervera R, Viñas O, Ramos-Casals M et al (2003) Anti-chromatin antibodies in systemic lupus erythematosus: a useful marker for lupus nephropathy. Ann Rheum Dis 62:431–434CrossRefPubMedGoogle Scholar
  17. 17.
    do Nascimento AP, Viana VST, Testagrossa LA et al (2006) Antibodies to ribosomal P proteins: a potential serologic marker for lupus membranous glomerulonephritis. Arthritis Rheum 54:1568–1572CrossRefPubMedGoogle Scholar
  18. 18.
    Renaudineau Y, Croquefer S, Jousse S, Renaudineau E et al (2006) Association of alpha-actinin-binding anti-double-stranded DNA antibodies with lupus nephritis. Arthritis Rheum 54:2523–2532CrossRefPubMedGoogle Scholar
  19. 19.
    Austin HA 3rd, Muenz LR, Joyce KM et al (1983) Prognostic factors in lupus nephritis. Contribution of renal histologic data. Am J Med 75:382–391CrossRefPubMedGoogle Scholar
  20. 20.
    Kaufman LD, Gomez-Reino JJ, Heinicke MH, Gorevic PD (1989) Male lupus: retrospective analysis of the clinical and laboratory features of 52 patients, with a review of the literature. Semin Arthritis Rheum 18:189–197CrossRefPubMedGoogle Scholar
  21. 21.
    Blum A, Rubinow A, Galun E (1991) Predominance of renal involvement in male patients with systemic lupus erythematosus. Clin Exp Rheumatol 9:206–207PubMedGoogle Scholar
  22. 22.
    Chang DM, Chang CC, Kuo SY, Chu SJ, Chang ML (1998) The clinical features and prognosis of male lupus in Taiwan. Lupus 7:462–468CrossRefPubMedGoogle Scholar
  23. 23.
    Molina JF, Drenkard C, Molina J et al (1996) Systemic lupus erythematosus in males. A study of 107 Latin American patients. Medicine (Baltimore) 75(12):4–130Google Scholar
  24. 24.
    Mok CC, Ho CT, Chan KW, Lau CS, Wong RW (2002) Outcome and prognostic indicators of diffuse proliferative lupus glomerulonephritis treated with sequential oral cyclophosphamide and azathioprine. Arthritis Rheum 46:1003–1010CrossRefPubMedGoogle Scholar
  25. 25.
    Yoo CW, Kim MK, Lee HS (2000) Predictors of renal outcome in diffuse proliferative lupus nephropathy: data from repeat renal biopsy. Nephrol Dial Transplant 15:1604–1608CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jozélio Freire de Carvalho
    • 1
  • Ana Patrícia do Nascimento
    • 1
  • Leonardo A. Testagrossa
    • 2
  • Rui Toledo Barros
    • 3
  • Eloísa Bonfá
    • 1
  1. 1.Rheumatology Division, Faculdade de MedicinaUniversidade de São Paulo e Hospital das ClínicasSão PauloBrazil
  2. 2.Pathology Department, Faculdade de MedicinaUniversidade de São Paulo e Hospital das ClínicasSão PauloBrazil
  3. 3.Nephrology Divisions, Faculdade de MedicinaUniversidade de São Paulo e Hospital das ClínicasSão PauloBrazil

Personalised recommendations