Abstract
Objective The frequency of end stage renal disease from SLE in the United States has not improved over the last few decades in large population datasets. Understanding the risk factors for renal failure in SLE could lead to earlier detection of lupus nephritis and potentially more effective treatments in those with markers of poor prognosis.
Methods The Hopkins Lupus Cohort, comprised of 2,528 patients was used. 151 patients experienced renal failure after SLE diagnosis, defined as dialysis or renal transplant. We estimated the risk of renal failure in subgroups defined by demographics, laboratory tests and ACR/SLICC Classification criteria satisfied within one year of SLE diagnosis.
Results The overall incidence of renal failure within 20 years of SLE diagnosis was 8.4%. The risk was much higher (20.0%) among those who experienced proteinuria within the first year of diagnosis. Demographic predictors included African American ethnicity (rate ratio 1.82, p=0.0012) and age less than 30 years at SLE diagnosis (rate ratio 1.96 vs. those with diagnosis over 40 years of age, p=0.019). Among immunologic markers, low C3 was a strong predictor of renal failure (Rate ratio 2.00, p=0.0011).
Conclusion Proteinuria within the first year of diagnosis of SLE is one of the most important predictors of end stage renal disease. Our data also confirm African American ethnicity, younger age at SLE diagnosis and low C3 as strong predictors of renal failure.
