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Long-term renal outcome and complications in South Africans with proliferative lupus nephritis

  • Nephrology - Original Paper
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Abstract

Aim

To report the long-term outcome and complication profile of South African patients with proliferative lupus nephritis (PLN).

Methods

A retrospective review of 66 patients with biopsy-proven PLN [58 diffuse proliferative LN (Class IV) and 8 focal proliferative LN (Class III)] under our care from January 1995 to December 2009 was done.

Results

Thirty-three (50 %) patients reached the composite end point of doubling of serum creatinine, end-stage renal disease (ESRD) or death. The 5-, 10- and 15-year cumulative event-free survival rates were 54, 34 and 27 %, respectively. Variables associated with the composite end point were simultaneous diagnosis of SLE and LN (p = 0.048); elevated serum creatinine at onset (p = 0.009); elevated systolic blood pressure (SBP) (p < 0.001) and elevated diastolic blood pressure (DBP) (p < 0.001) on follow-up; and non-remission following induction therapy (p < 0.001). The 5-, 10- and 15-year renal survival rates in our patients were 63, 52 and 52 %, respectively. Hypertension at onset of LN (p = 0.037), nephrotic-range proteinuria (p = 0.033), eGFR < 60 ml/min/1.73 m2 (p = 0.013) and lack of remission following induction therapy (p < 0.001) were all associated with development of end-stage renal disease (ESRD). Elevated SBP on follow-up (95 % CI 1.03–1.34, p = 0.017) was the only factor associated with composite end point while failure to achieve remission following induction therapy was the only factor associated with ESRD on multivariate analysis. Thirty-five (53 %) patients developed complications with persistent leukopenia, gastritis, sepsis, tuberculosis (TB) and herpes zoster being the leading complications. Ovarian failure occurred in 4 (11 %) patients.

Conclusion

The 5-, 10 and 15-year event-free survival rates were 54, 34 and 27 % and failure to achieve remission following induction therapy predicted poor renal survival on multivariate analysis.

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Acknowledgments

Dr Ayodele Olugbenga Edward was funded by the International Society of Nephrology (ISN) Fellowship Training Award during his period of training at Groote Schuur Hospital. We want to thank all the doctors who were involved in the out-patient and in-patient management of these patients. This work was partly presented at the 27th South African Congress of Nephrology which was held on 16–19 April 2010, at the International Convention Centre, Cape Town, South Africa.

Conflict of interest

None declared by the authors.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Ladoke Akintola University of Technology, P.O. Box 710, Ogbomoso, Osogbo, Nigeria

    Olugbenga E. Ayodele

  2. Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Observatory, 7925, Cape Town, South Africa

    Ikechi G. Okpechi & Charles R. Swanepoel

Authors
  1. Olugbenga E. Ayodele
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  2. Ikechi G. Okpechi
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  3. Charles R. Swanepoel
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Correspondence to Ikechi G. Okpechi.

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Ayodele, O.E., Okpechi, I.G. & Swanepoel, C.R. Long-term renal outcome and complications in South Africans with proliferative lupus nephritis. Int Urol Nephrol 45, 1289–1300 (2013). https://doi.org/10.1007/s11255-012-0376-9

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  • DOI: https://doi.org/10.1007/s11255-012-0376-9

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