Skip to main content

Advertisement

SpringerLink
Log in

Clinicopathologic characteristics and outcomes of late onset lupus nephritis: a single centre experience

  • Observational Research
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Systemic Lupus Erythematosus (SLE) occurs in the reproductive age group. Renal involvement occurs less frequently in late-onset SLE than in reproductive-age SLE patients. Here, we aimed to study the clinical, serological and histopathological characteristics of late-onset lupus nephritis (LN). Late-onset LN was defined as disease onset after 47 years of age, corresponding to the average menopausal age. Records of biopsy proven late-onset lupus nephritis patients diagnosed between June 2000 and June 2020 were reviewed. Late-onset LN constituted 53 of 4420 patients (1.2%) biopsied during the study period. Females represented 90.65% of the cohort. Mean age of the cohort was 49.5 ± 7.05 years at the time of SLE diagnosis while its renal presentation was delayed by median duration of 10 months (IQR 3–48 months). Renal failure was present in 28 patients (52.8%) with acute kidney injury (AKI) (28.3%, n = 15) as the most common presentation. On histopathological analysis, class IV was observed in 23 patients (43.5%), crescents were observed in one-third cases and lupus vasculopathy in 4 patients (7.5%). All patients received steroids. Majority of patients (43.3%; n = 23) received Euro lupus protocol for induction. On median follow up duration of 82 months, renal flares were noted in 9 patients (17%) and 8 patients (15.1%) became dialysis dependent. Among 11 patients (21%) with infectious complications, 7 patients (13.2%) suffered from tuberculosis. Infections caused three-fourth of the deaths. Late-onset lupus nephritis is rare and presents as renal failure in majority. Renal biopsy affects the clinical decision of judicious use of immunosuppression which is imperative due to high rate of infections in this cohort.

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

Similar content being viewed by others

Data availability

Data are confidential and will be shared only with a strong reasoning.

References

  1. Kaul A, Gordon C, Crow MK, Touma Z, Urowitz MB, van Vollenhoven R et al (2016) Systemic lupus erythematosus. Nat Rev Dis Primer 2(1):1–21

    Article  Google Scholar 

  2. Shah L, Elshaikh AO, Lee R, Joy Mathew C, Jose MT, Cancarevic I (2023) Do menopause and aging affect the onset and progression of rheumatoid arthritis and systemic lupus erythematosus? Cureus 12(10):e10944

    Google Scholar 

  3. Khan A, Sawant T, Deen Z, Humayun W, Humayun Y (2023) Systemic lupus erythematosus in the elderly that debuts with an organic manifestation of lupus nephritis. Cureus 14(9):e28746

    Google Scholar 

  4. Ahuja M (2016) Age of menopause and determinants of menopause age: a PAN India survey by IMS. J Life Health 7(3):126–131

    Article  Google Scholar 

  5. Tang Z, Chen D, Yang S, Zhang H, Hu W, Liu Z et al (2011) Late onset lupus nephritis: analysis of clinical manifestations and renal pathological features in Chinese patients. Rheumatol Int 31(12):1625–1629

    Article  PubMed  Google Scholar 

  6. Boddaert J, Huong DLT, Amoura Z, Wechsler B, Godeau P, Piette JC (2004) Late-onset systemic lupus erythematosus: a personal series of 47 patients and pooled analysis of 714 cases in the literature. Medicine (Baltimore) 83(6):348–359

    Article  PubMed  Google Scholar 

  7. Aringer M, Costenbader KH, Daikh DI, Brinks R, Mosca M, Ramsey-Goldman R et al (2019) 2019 EULAR/ACR classification criteria for systemic lupus erythematosus. Arthritis Rheumatol (Hoboken, NJ) 71(9):1400–1412

    Article  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Rovin BH, Adler SG, Barratt J, Bridoux F, Burdge KA, Chan TM et al (2021) KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int 100(4):S1-276

    Article  Google Scholar 

  10. Wen L, Chen Z, Jin Z, Pan W, Liu L, Wu M et al (2022) Clinical and laboratorial outcome of different age-onset systemic lupus erythematosus patients in Jiangsu, China: a multicentre retrospective study. Sci Rep 12(1):10683

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Rovenský J, Tuchynová A (2008) Systemic lupus erythematosus in the elderly. Autoimmun Rev 7(3):235–239

    Article  PubMed  Google Scholar 

  12. Lin H, Wei JCC, Tan CY, Liu YY, Li YH, Li FX et al (2012) Survival analysis of late-onset systemic lupus erythematosus: a cohort study in China. Clin Rheumatol 31(12):1683–1689. https://doi.org/10.1007/s10067-012-2073-6

    Article  PubMed  Google Scholar 

  13. 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(1):28–34

    Article  CAS  PubMed  Google Scholar 

  14. Rijnink EC, Teng YKO, Wilhelmus S, Almekinders M, Wolterbeek R, Cransberg K et al (2017) Clinical and histopathologic characteristics associated with renal outcomes in lupus nephritis. Clin J Am Soc Nephrol (CJASN) 12(5):734–743

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gonzalez-Suarez ML, Waheed AA, Andrews DM, Ascherman DP, Zeng X, Nayer A (2014) Lupus vasculopathy: diagnostic, pathogenetic and therapeutic considerations. Lupus 23(4):421–427

    Article  CAS  PubMed  Google Scholar 

  16. Pu SJ, Luo SF, Wu YJJ, Cheng HS, Ho HH (2000) The clinical features and prognosis of lupus with disease onset at age 65 and older. Lupus 9(2):96–100. https://doi.org/10.1191/096120300678828109

    Article  CAS  PubMed  Google Scholar 

  17. Kutky M, Aloudat S (2018) Late-onset systemic lupus erythematosus with lupus nephritis in a 74-year-old male: a brief case and review. Can J Kidney Health Dis 5:2054358118793397

    Article  PubMed  PubMed Central  Google Scholar 

  18. Das SK, Biswas U, Biswas S, Jana CK (2015) The old man with heavy proteinuria: An uncommon case of lupus nephropathy in elderly male. Med J Dr Patil Univ 8(1):81

    Article  Google Scholar 

  19. Ünlü O, Zuily S, Erkan D (2016) The clinical significance of antiphospholipid antibodies in systemic lupus erythematosus. Eur J Rheumatol 3(2):75–84

    Article  PubMed  Google Scholar 

  20. Amann K (2017) Do ANCAs make the difference in lupus nephritis? Kidney Int 92(5):1048–1050

    Article  CAS  PubMed  Google Scholar 

  21. Tektonidou MG, Dasgupta A, Ward MM (2016) Risk of end-stage renal disease in patients with lupus nephritis, 1971–2015. Arthritis Rheumatol (Hoboken, NJ) 68(6):1432–1441

    Article  Google Scholar 

  22. Dooley MA, Jayne D, Ginzler EM, Isenberg D, Olsen NJ, Wofsy D et al (2011) Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. N Engl J Med 365(20):1886–1895

    Article  CAS  PubMed  Google Scholar 

  23. Tam LS, Li EK, Wong SM, Szeto CC (2002) Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong. Scand J Rheumatol 31(5):296–300

    Article  PubMed  Google Scholar 

  24. 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

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge the contribution made by pathology technicians and the staff of nephrology ward who helped in making diagnosis and providing care to the patients.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Harshita Sharma, Anupma Kaul, Sourya Sourabh Mohakuda, Manas Ranjan Behera, D. S. Bhadauria, Narayan Prasad & Manas Ranjan Patel

  2. Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Vinita Agrawal & Anshima Singh

  3. Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Vikas Agarwal

Authors
  1. Harshita Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anupma Kaul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sourya Sourabh Mohakuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manas Ranjan Behera
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. S. Bhadauria
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vinita Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vikas Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Narayan Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Anshima Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Manas Ranjan Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Harshita Sharma,Anupma Kaul, Sourya Sourabh Mohakuda contributed equally.

Corresponding author

Correspondence to Anupma Kaul.

Ethics declarations

Conflict of interest

None of the authors have any conflict of interest.

Ethical standards

Approval was obtained from the ethics committee of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. The procedures used in this study adhere to the tenets of the Declaration of Helsinki (IEC number- 2023-147-IP-132).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, H., Kaul, A., Mohakuda, S.S. et al. Clinicopathologic characteristics and outcomes of late onset lupus nephritis: a single centre experience. Rheumatol Int 43, 1849–1858 (2023). https://doi.org/10.1007/s00296-023-05357-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-023-05357-8

Keywords

Search

Navigation