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Predictors of end stage renal disease in African Americans with lupus nephritis
Carlos Franco1, Wonsuk Yoo, Domingo Franco
1Departments of Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, MI 4820, USA. drcarlosfranco@yahoo.com
Insights
Hypertension, elevated creatinine, and proliferative lupus nephritis predict end-stage renal disease (ESRD) in African Americans. Class V lupus nephritis showed a lower risk of ESRD, highlighting key factors for this population.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- Lupus nephritis is a severe manifestation of systemic lupus erythematosus (SLE).
- African Americans experience more severe lupus nephritis and higher rates of end-stage renal disease (ESRD) compared to Caucasians.
- Predictors of ESRD in lupus nephritis include elevated creatinine, low complement levels, thrombocytopenia, anemia, hypertension, and proliferative glomerulonephritis.
Purpose of the Study:
- To identify clinical, serological, and immunological predictors of ESRD requiring dialysis specifically in the African American population.
- To correlate specific lupus nephritis classes with the risk of developing ESRD.
Main Methods:
- Retrospective study of 67 African American patients with lupus nephritis diagnosed and biopsied between 1996 and 2006.
- Analysis of clinical, serological, and immunological variables.
- Statistical methods included chi-square, t-tests, ANOVA, and logistic regression models to identify ESRD predictors.
Main Results:
- Prognosis for renal function was poorer in proliferative lupus nephritis forms.
- Elevated erythrocyte sedimentation rate (ESR) was observed in lupus nephritis classes III, IV, and V.
- Higher creatinine, decreased glomerular filtration rate (GFR), class IV lupus nephritis, and hypertension were associated with ESRD.
- Class V lupus nephritis demonstrated a significantly lower risk of progression to ESRD (p < 0.05).
- Low C3 and C4 levels were not significantly associated with ESRD in subgroup analysis.
Conclusions:
- Hypertension, elevated creatinine, proliferative nephritis, and decreased GFR are confirmed predictors of ESRD in lupus nephritis patients requiring dialysis.
- Class V lupus nephritis appears to have a protective effect against progression to ESRD.
- Findings emphasize the importance of monitoring specific clinical and pathological factors in African Americans with lupus nephritis to predict ESRD risk.
Unlabelled:
Lupus nephritis is one of the most serious manifestations of systemic lupus erythematosus (SLE). African Americans generally have a more severe presentation and more often progress to end stage renal disease (ESRD) than Caucasians. Several studies point to higher creatinine, low complement levels, thrombocytopenia, anemia, hypertension, and proliferative glomerulonephritis as predictors of ESRD in lupus nephritis within multi-ethnic cohorts. The purpose of the current study was to correlate clinical, serological, and immunological variables with the development of ESRD requiring dialysis in the African American population.
Materials And Methods:
A small retrospective study was performed with African American patients who had been diagnosed with lupus nephritis and biopsied between 1996 and 2006. Clinical, serological, and immunological variables were investigated. Chi square, t-test, ANOVA, and univariate and multivariable logistic regression models were applied to identify predictors of adverse outcome (ESRD requiring dialysis) in 67 patients with lupus nephritis. Sub-group analyses were performed in some cases to evaluate differences among the different classes.
Results:
Renal function was more depressed in the proliferative forms of lupus nephritis. Erythrocyte sedimentation rate (ESR) was increased mostly in classes III, IV, and V. Complement levels were uniformly decreased in the population studied. Nonetheless, C4 was more significantly depressed in the proliferative forms of lupus nephritis. We found that higher creatinine values (defined as creatinine greater than 1.2), low glomerular filtration rate (GFR) defined as GFR less than 60 mL/min/1.73 m2), class IV lupus nephritis, and hypertension are associated with ESRD in this population. On the other hand, class V lupus nephritis patients had significantly less risk to progress to ESRD (p values < 0.05). On subgroup analysis, neither low C3 nor low C4 levels were associated with ESRD requiring dialysis.
Conclusion:
As previously noted in other studies, hypertension, higher creatinine, proliferative nephritis, and decreased GFR are associated with ESRD requiring dialysis.
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