Predictors of end stage renal disease in African Americans with lupus nephritis

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. Subgroup 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.