Predictive factors of developing lupus nephritis in systemic lupus erythematosus

Renal involvement is common in systemic lupus erythematosus (SLE), and even without elevated serum creatinine, there is a high proportion of abnormal urine analysis in these patients. Lupus nephritis (LN) develops early in the course of the disease in 50% of SLE patients, and end stage renal disease (ESRD) occurs in 4.3-10.1%. We performed a keyword-based literature search and included 31 articles published from 2004 to 2023. Ethnic and racial differences may affect LN, including higher incidence of LN in Black, Hispanic and Asian compared with white patients. In addition, male sex, longer disease duration, smoking, low albumin globulin ratio, low complement, anti-double stranded DNA, high anti-Sm is associated with disease progression to LN. High serum creatinine (>1.5 mg/dL) at disease onset is the most commonly reported independent clinical laboratory predictor for ESRD in patients with SLE. Other factors indicating an increased risk for ESRD are higher chronicity index, high systolic blood pressure, black race, male sex, hypocomplementemia, class of LN (III, IV and V) and older age.