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Lupus Nephritis: Management Principles

Ian N Bruce Arthritis Research UK Epidemiology Unit The University of Manchester and The Kellgren Centre for Rheumatology Manchester Royal Infirmary

Lupus in kidney (nephritis)

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Lupus nephritis The disease

Decisions

The drugs

Lupus nephritis The disease

The drugs

Decisions

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Lupus nephritis prevalence Ethnic group

Estimated prevalence (women)

Estimated prevalence (overall)

Standardised prevalence ratio

White Caucasian

5.6 (4.7-6.7)

3.5 (3.0-4.1)

1.0

Indo-Asian

21.4 (12-35.0)

13.3 (7.9-21.0)

3.8 (2.3-6.0)

African-Caribbean

99.0 (55.5-163.6)

64.6 (39-101.0)

18.6 (11.0-29.0)

Chinese

110.3 (55.0-197.3)

66.7 (35.0-114.0)

19.2 (10.0-33.0) Patel et al Arthritis Rheum 2006

Prevalence/ 100,000 population

Lupus nephritis estimated relative prevalence Ethnic group Number with Number with Estimated % SLE lupus with nephritis (NW nephritis England) White Caucasian

1633

158

9.7%

Indo-Asians

68

18

26.4%

AfricanCaribbean

33

19

58%

Patel et al Arthritis Rheum 2006

Lupus nephritis Clinical Prognostic Factors • • • •

Non-Caucasian (UK) Smoking Hypertension High non-renal activity

• Raised creatinine at presentation • Delay in immunosuppression / biopsy

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Lupus nephritis Biopsy Prognostic Factors • Glomerular – proliferative lesions – high activity – any chronicity • Tubulointerstitial – activity or chronicity

Lupus nephritis prognosis (historical) • Initial studies in 1950s – Low dose steroids – 5-yr survival