Moroni G, et al. - Authors assessed the changes in demographic, clinical and histological presentation, and prognosis of lupus nephritis (LN) over time. Results suggested that in the last years, clinical presentation of LN has become less severe leading to a better long-term renal survival.

Methods

• A multicentre cohort of 499 patients diagnosed with LN from 1970 to 2016 was studied by the experts.
• They subdivided the 46-year follow-up into 3 periods (P): P1 1970–1985, P2 1986–2001 and P3 2002–2016, and patients accordingly grouped based on the year of LN diagnosis.
• They investigated the predictors of patient and renal survival by univariate and multivariate proportional hazards Cox regression analyses.
• Using the log-rank test, survival curves were compared.

Results

• Researchers observed a progressive increase in patient age at the time of LN diagnosis (p < 0.0001) and a longer time between systemic lupus erythematosus onset and LN occurrence (p < 0.0001) from 1970 to 2016.
• Findings suggested that during the same period the frequency of renal insufficiency at the time of LN presentation progressively decreased (p < 0.0001) and that of isolated urinary abnormalities increased (p < 0.0001).
• As per data, in histological class and activity index no changes were observed, while chronicity index significantly decreased from 1970 to 2016 (p=0.023).
• Results demonstrated that the survival without end-stage renal disease (ESRD) in P1 was 87%, in P2 it was 94% and in P3 it was 99% at 10 years, 80% in P1 and 90% in P2 at 20 years (p=0.0019).
• At multivariate analysis, independent predictors of ESRD were male gender, arterial hypertension, absence of maintenance immunosuppressive therapy, increased serum creatinine, and high activity and chronicity index.