A Prospective Longitudinal Follow-Up Study of the Pattern, Clinical Presentation and Outcome of Lupus Nephritis in Adult Nigerians

Abstract

SLE, a multisystem autoimmune disease with predominant female and racial predilection is thought to be uncommon in our setting though the incidence is increasing. Lupus Nephritis commonly complicate SLE and is recognised to be a major predictor of mortality. To assess clinical characteristics, renal histopathology and response to treatment with steroid and/or immunosuppressive therapy. We also set out to determine (if any) factors that portend worse outcome. 

We prospectively followed up 28 patients that fulfilled the inclusion criteria which included 1. Presence of four or more (e”4) American College of  Rheumatology (ACR criteria) for diagnosis of SLE 2. Presence of proteinuria, reduced glomerular filtration rate < 60ml/min or uraemia. Socio-demographic data, clinical and laboratory parameters were collated. All patients were commenced on a combination of ACEI, diuretics and steroids.  Induction remission therapy was done using I.V. methylprednisolone 500mg daily for three days and maintenance therapy with prednisolone at the
dose of 1.5mg/kg/day which was later tapered. Unresponsive patients were offered Mycophenolate mofetil or Azathioprine or cyclophosphamide or
Cyclosporin A in addition to steroids. Outcome measures included induction of remission, reduction / worsening of proteinuria or death. Data was
analysed using SPSS package version 16. The age ranged between 15 and 63yrs (mean± S.D.; 31.7±1.28yrs). The common clinical findings at the time of diagnosis included body swelling (89%), facial rash (85%), frothy urine (82%), joint pain (64%) and anaemia (75%). Seventy percent of them had
massive proteinuria with the mean (±SD) of 3.74(±1.37)g / day. Antinuclear antibodies and anti-double-stranded DNA antibodies were detected in all the patients that had the test, however, only 17.8% were LE Cell positive. Of the 10 patients that had renal biopsy done 4 had membranous GN (stage V). Fifteen patients presented with end-stage renal disease, 13(46.4%) had HD while CAPD and renal transplantation were offered to 1(3.5%) and 2(7.01%) respectively. Six (21.4%) patients had sustained remission while another 6 (21.4%) had between 1-3 relapses during the follow-up period. The mean duration of survival after diagnosis was 20±1.56months. Nephritis is a major complication of SLE and significantly contributes to mortality.
Immunosuppressive drugs are vital to attainment and sustenance of clinical/biochemical remission and renal failure and infection were the major causes of mortality.