Review of the Patterns of Clinical Presentation, Histopathological Classes, and Outcomes of Lupus Nephritis Patients at a Tertiary care facility in Johannesburg, South Africa

Abstract

Abstract Background: Lupus nephritis (LN) is a significant factor in the burden of secondary glomerular disease in South Africa and has a poorer prognosis in people of African descent. Early identification and treatment are required to impact patient outcomes meaningfully. Methods: A retrospective review of biopsy-proven LN diagnosed over a 10-year period was undertaken. Clinical, histopathology, and renal outcomes data were tested with logistic regression and general discriminant analysis. Survival curves of renal outcomes were also calculated. Results: Over the 10-year study period, 47 patients were identified. The majority (72.7%) of patients were of Black African ancestry with median age at diagnosis of 26.5 years. Proliferative LN lesions predominated (66%) and were associated with higher creatinine (p = 0.007). An estimated glomerular filtration rate (eGFR) below 90mL/min/1.73m2 increased the odds of proliferative LN (OR = 5.60; CI 1.06-29.59; p = 0.043). Proliferative LN was associated with a trend towards poorer renal outcomes (p = 0.057); higher baseline eGFR was associated with better-preserved kidney function at follow-up (p = 0.003). Baseline urine white cell count inversely correlated with eGFR and directly correlated with serum creatinine at follow-up (p = 0.041 and p = 0.001, respectively) Conclusion: The present study demonstrates a possible role for baseline eGFR and leukocyturia in predicting the presence of proliferative LN. Since proliferative LN is associated with poorer kidney survival, these investigations may identify patients likely to benefit from empiric high-dose immunosuppression when access to biopsy confirmation is delayed.