Predictors of mortality and end stage renal disease in Saudi patients with lupus nephritis

The purpose of this study was to investigate the presentation and factors affecting outcome over a 9-year period in 99 consecutive Saudi patients with biopsy proven lupus nephritis (LN), 35.5% of whom had nephrotic range proteinuria, 46.8% had estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) and 65.5% had histological class IV. The female:male ratio was 3.7:1. During the observation period, there were significant rises in eGFR (p = 0.005), C4 (p = 0.000) and significant decrease in 24-h urine protein (p = 0.028). No correlation was found between final eGFR and baseline 24-h protein, anti-DNA, C3 or C4. Female patients had a significantly higher rise in eGFR (p = 0.05).During follow-up (FU), 28.2% required dialysis. The survival rates at 5, 10 and 15 years were 92%, 77% and 77% respectively. Baseline C3 and C4 levels were significantly lower in the patients who died (p = 0.0001 and 0.02 respectively). Those who required dialysis were more likely to die (p < 0.000) (risk ratio = 4.46; 95% confidence interval 2.8-7.2). Hypertension at presentation was associated with lower baseline eGFR (p = 0.01) and final eGFR (p = 0.002) but did not affect the baseline proteinuria. Baseline eGFR of <60 ml/min/1.73 m(2) at presentation was associated with lower eGFR at end of FU (p = 0.000), higher activity score (p = 0.0001) and chronicity scores (p = 0.017).