Skip to main content
SpringerLink
Log in

Clinicopathological study of male and female patients with lupus nephritis: a retrospective study

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess the impact of sex on long-term outcomes in patients with lupus nephritis (LN).

Methods

Data of patients were collected at a single tertiary hospital from June 2010 to June 2016. Clinicopathological features and treatment responses of LN patients with different genders were compared. The primary endpoint was serum creatinine level doubled, GFR < 15 mL/min, initiation of renal replacement treatment or death. The secondary endpoint was complete remission or partial remission.

Results

In total, 101 male patients and 579 females were included. The follow-up time was 49.7 ± 15.2 months. In clinical data, photosensitivity and mouth ulcers were more common in the female patients, while males had more serositis and vasculitis. In laboratory data, males had higher values of blood pressure, hemoglobin, urine protein, serum creatinine and a lower level of serum albumin. Activity index and endocapillary hypercellularity scores in the male group were significantly increased. No sex disparity was identified across secondary endpoints in all cases, despite a lower ratio of CR in males. As for the long-term survival, no statistic difference between the two groups was observed. In a further multivariate Cox hazard analysis, male gender was not identified as an independent risk factor for poor outcomes.

Conclusion

Despite a greater disease activity and more severe organ damage in males with LN, we did not observe any significant gender disparity in long-term survival. Large multicenter collaborative efforts are necessary.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cameron JS (1999) Lupus nephritis. J Am Soc Nephrol 10(2):413–424

    CAS  PubMed  Google Scholar 

  2. Jakes RW, Bae SC, Louthrenoo W, Mok CC, Navarra SV, Kwon N (2012) Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality. Arthritis Care Res 64(2):159–168. https://doi.org/10.1002/acr.20683

    Article  Google Scholar 

  3. Galindo-Izquierdo M, Rodriguez-Almaraz E, Pego-Reigosa JM, Lopez-Longo FJ, Calvo-Alen J, Olive A, Fernandez-Nebro A, Martinez-Taboada V, Vela-Casasempere P, Freire M, Narvaez FJ, Rosas J, Ibanez-Barcelo M, Uriarte E, Tomero E, Zea A, Horcada L, Torrente V, Castellvi I, Calvet J, Menor-Almagro R, Zamorano MA, Raya E, Diez-Alvarez E, Vazquez-Rodriguez T, Garcia de la Pena P, Movasat A, Andreu JL, Richi P, Marras C, Montilla-Morales C, Hernandez-Cruz B, Marenco de la Fuente JL, Gantes M, Ucar E, Alegre-Sancho JJ, Manero J, Ibanez-Ruan J, Rodriguez-Gomez M, Quevedo V, Hernandez-Beriain J, Silva-Fernandez L, Alonso F, Perez S, Rua-Figueroa I (2016) Characterization of patients with lupus nephritis included in a large cohort from the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER). Medicine 95(9):e2891. https://doi.org/10.1097/md.0000000000002891

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Tang Y, Zhang X, Ji L, Mi X, Liu F, Yang L, Qin W (2015) Clinicopathological and outcome analysis of adult lupus nephritis patients in China. Int Urol Nephrol 47(3):513–520. https://doi.org/10.1007/s11255-014-0903-y

    Article  PubMed  Google Scholar 

  5. Tan TC, Fang H, Magder LS, Petri MA (2012) Differences between male and female systemic lupus erythematosus in a multiethnic population. J Rheumatol 39(4):759–769. https://doi.org/10.3899/jrheum.111061

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheumatol 40(9):1725. https://doi.org/10.1002/1529-0131(199709)40:9<1725:AID-ART29>3.0.CO;2-Y

    Article  CAS  Google Scholar 

  7. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A (2007) ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC task force on the management of arterial hypertension. J Hypertens 25(9):1751–1762. https://doi.org/10.1097/HJH.0b013e3282f0580f

    Article  CAS  PubMed  Google Scholar 

  8. Gladman DD, Ibanez D, Urowitz MB (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol 29(2):288–291

    PubMed  Google Scholar 

  9. Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 15(2):241–250

    Article  PubMed  Google Scholar 

  10. Austin HA 3rd, Muenz LR, Joyce KM, Antonovych TA, Kullick ME, Klippel JH, Decker JL, Balow JE (1983) Prognostic factors in lupus nephritis. Contribution of renal histologic data. Am J Med 75(3):382–391

    Article  PubMed  Google Scholar 

  11. Mosca M, Pasquariello A, Tavoni A, Moriconi L, Moneta I, Innocenti M, Bencivelli W, Bombardieri S (1997) Predictors of renal outcome in diffuse proliferative glomerulonephritis in systemic lupus erythematosus. Lupus 6(4):371–378. https://doi.org/10.1177/096120339700600405

    Article  CAS  PubMed  Google Scholar 

  12. Esdaile JM, Levinton C, Federgreen W, Hayslett JP, Kashgarian M (1989) The clinical and renal biopsy predictors of long-term outcome in lupus nephritis: a study of 87 patients and review of the literature. Q J Med 72(269):779–833

    CAS  PubMed  Google Scholar 

  13. Beck L, Bomback AS, Choi MJ, Holzman LB, Langford C, Mariani LH, Somers MJ, Trachtman H, Waldman M (2013) KDOQI US commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis. Am J Kidney Dis 62(3):403–441. https://doi.org/10.1053/j.ajkd.2013.06.002

    Article  PubMed  Google Scholar 

  14. Radhakrishnan J, Cattran DC (2012) The KDIGO practice guideline on glomerulonephritis: reading between the (guide)lines–application to the individual patient. Kidney Int 82(8):840–856. https://doi.org/10.1038/ki.2012.280

    Article  PubMed  Google Scholar 

  15. Mok CC, Ying KY, Ng WL, Lee KW, To CH, Lau CS, Wong RW, Au TC (2006) Long-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide. Am J Med 119(4):355. https://doi.org/10.1016/j.amjmed.2005.08.045

    Article  PubMed  Google Scholar 

  16. Tang Y, Qin W, Peng W, Tao Y (2017) Development and validation of a prediction score system in lupus nephritis. Medicine 96(37):e8024. https://doi.org/10.1097/md.0000000000008024

    Article  PubMed  PubMed Central  Google Scholar 

  17. Garcia MA, Marcos JC, Marcos AI, Pons-Estel BA, Wojdyla D, Arturi A, Babini JC, Catoggio LJ, Alarcon-Segovia D (2005) Male systemic lupus erythematosus in a Latin-American inception cohort of 1214 patients. Lupus 14(12):938–946. https://doi.org/10.1191/0961203305lu2245oa

    Article  CAS  PubMed  Google Scholar 

  18. Wang YF, Xu YX, Tan Y, Yu F, Zhao MH (2012) Clinicopathological characteristics and outcomes of male lupus nephritis in China. Lupus 21(13):1472–1481. https://doi.org/10.1177/0961203312458467

    Article  PubMed  Google Scholar 

  19. Ntatsaki E, Isenberg D (2015) Risk factors for renal disease in systemic lupus erythematosus and their clinical implications. Expert Rev Clin Immunol 11(7):837–848. https://doi.org/10.1586/1744666x.2015.1045418

    Article  CAS  PubMed  Google Scholar 

  20. Hoffman IE, Peene I, Meheus L, Huizinga TW, Cebecauer L, Isenberg D, De Bosschere K, Hulstaert F, Veys EM, De Keyser F (2004) Specific antinuclear antibodies are associated with clinical features in systemic lupus erythematosus. Ann Rheum Dis 63(9):1155–1158. https://doi.org/10.1136/ard.2003.013417

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Lee PY, Yeh KW, Yao TC, Lee WI, Lin YJ, Huang JL (2013) The outcome of patients with renal involvement in pediatric-onset systemic lupus erythematosus–a 20-year experience in Asia. Lupus 22(14):1534–1540. https://doi.org/10.1177/0961203313502110

    Article  PubMed  Google Scholar 

  22. Scofield RH, Bruner GR, Namjou B, Kimberly RP, Ramsey-Goldman R, Petri M, Reveille JD, Alarcon GS, Vila LM, Reid J, Harris B, Li S, Kelly JA, Harley JB (2008) Klinefelter’s syndrome (47, XXY) in male systemic lupus erythematosus patients: support for the notion of a gene-dose effect from the X chromosome. Arthritis Rheum 58(8):2511–2517. https://doi.org/10.1002/art.23701

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cunningham M, Gilkeson G (2011) Estrogen receptors in immunity and autoimmunity. Clin Rev Allergy Immunol 40(1):66–73. https://doi.org/10.1007/s12016-010-8203-5

    Article  CAS  PubMed  Google Scholar 

  24. Hwang J, Lee J, Ahn JK, Park EJ, Cha HS, Koh EM (2015) Clinical characteristics of male and female Korean patients with systemic lupus erythematosus: a comparative study. Korean J Intern Med 30(2):242–249. https://doi.org/10.3904/kjim.2015.30.2.242

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mok CC, Lau CS, Chan TM, Wong RW (1999) Clinical characteristics and outcome of southern Chinese males with systemic lupus erythematosus. Lupus 8(3):188–196. https://doi.org/10.1191/096120399678847605

    Article  CAS  PubMed  Google Scholar 

  26. Riveros Frutos A, Casas I, Rua-Figueroa I, Lopez-Longo FJ, Calvo-Alen J, Galindo M, Fernandez-Nebro A, Pego-Reigosa JM, Olive Marques A (2017) Systemic lupus erythematosus in Spanish males: a study of the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort. Lupus 26(7):698–706. https://doi.org/10.1177/0961203316673728

    Article  CAS  PubMed  Google Scholar 

  27. Ayodele OE, Okpechi IG, Swanepoel CR (2010) Predictors of poor renal outcome in patients with biopsy-proven lupus nephritis. Nephrology (Carlton, Vic) 15(4):482–490. https://doi.org/10.1111/j.1440-1797.2010.01290.x

    Article  Google Scholar 

  28. Dhir V, Aggarwal A, Lawrence A, Agarwal V, Misra R (2012) Long-term outcome of lupus nephritis in Asian Indians. Arthritis Care Res 64(5):713–720. https://doi.org/10.1002/acr.21597

    Article  Google Scholar 

  29. Kasitanon N, Magder LS, Petri M (2006) Predictors of survival in systemic lupus erythematosus. Medicine 85(3):147–156. https://doi.org/10.1097/01.md.0000224709.70133.f7

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to warmly thank Prof. Cai-Rong Zhu from the Department of Health Statistics, West China School of Public Health, Sichuan University, due to her help.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Author notes

  1. Wei Peng and Yi Tang have contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Nephrology, West China Hospital, Sichuan University, 37th Guoxuexiang Road, Chengdu, 610041, China

    Wei Peng, Yi Tang, Li Tan & Wei Qin

Authors
  1. Wei Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yi Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Qin.

Ethics declarations

Conflict interest

The authors declare that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peng, W., Tang, Y., Tan, L. et al. Clinicopathological study of male and female patients with lupus nephritis: a retrospective study. Int Urol Nephrol 50, 313–320 (2018). https://doi.org/10.1007/s11255-017-1780-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-017-1780-y

Keywords

Search

Navigation