Prospective Cohart study of clinical outcomes and prognostic factors in lupus nephritis in a tertiary care centre in South India

Suceena, Alexander (2007) Prospective Cohart study of clinical outcomes and prognostic factors in lupus nephritis in a tertiary care centre in South India. Masters thesis, Christian Medical College, Vellore.

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Abstract

INTRODUCTION : Systemic Lupus Erythematosus (SLE), more a syndrome than a disease, is the prototype of immune complex mediated systemic autoimmune diseases. A prevalence study in India showed a crude incidence rate of 4 per 100,000 population per year. It has been diagnosed in 1.5 million people in the United States. Women have a much higher risk of developing SLE, and the woman-to-man ratio is about 10-15:1. Racial differences are present and it is seen that women of black, Hispanic, Asian, and Native American backgrounds are more frequently affected than their white peers. SLE, though a disease known for over half a century, still carries a grim prognosis. More than half of these patients develop irreversible organ damage over time1. Lupus nephritis occurs in about half of SLE patients in India as per published series reporting between 35-73% occurrences. Renal involvement in SLE occurs early in the disease and is usually within 10 years of the appearance of SLE. Studies have suggested that male lupus nephritis patients have more severe disease than their female counterparts. Lupus nephritis is seen more in Asians, African-Caribbeans and African- Americans. In a retrospective study published in 1988 by McCune et al, male sex, young age (<33years), and non-European ancestry were determinants of earlier renal involvement in SLE patients. With modern treatment, the survival of SLE patients have improved in the west to about 80% at 10 years after diagnosis but, the figures for the Asian Indians are not so good. Murali et al in a study of 98 patients between 1981 and 1993 showed 50%-60% survival of SLE patients at 10 years. It is a therapeutic challenge to treat lupus nephritis, since early intervention can dramatically change the disease course. AIM : T o describe the presentation of lupus nephritis, its prognostic factors, outcome measures and their correlation in patients with lupus nephritis on treatment for six months. OBJECTIVES : 1. To describe the presentation of lupus nephritis in our population 2. To describe the clinical outcome of lupus nephritis in patients treated with various regimens at six months. 3. To identify predictors of outcome of lupus nephritis in our population. MATERIALS AND METHODS : Setting Study was conducted among the patients presenting to the in-patient and out-patient services of the Department of Medicine and Nephrology of the Christian Medical College (CMC), Vellore, South India which is an 1800 bedded tertiary care teaching hospital. Duration of Study : August 2004 to July 2006. The recruitment of patients ended in January 2006 and the follow up period in July 2006. Inclusion Criteria : 1. All consecutive adult SLE patients (age >12 years). 2. Diagnosed with lupus nephritis by Renal biopsy in the Department of Medicine and Nephrology. 3. Follow up for 6 months, availing out-patient clinic/ in-patient services between August 2004 and July 2006. Exclusion Criteria : 1. Age < 12 years. 2. Renal disease other than SLE. 3. Less than 6 months of follow up. Study Design : The study was a Prospective Cohort study on consecutive Lupus Nephritis patients diagnosed in our centre. DISCUSSION : 83 consecutive patients who were diagnosed to have SLE and admitted for renal biopsy were recruited into the study. These patients were admitted either in Medicine or in Nephrology wards for biopsy. Follow up was through outpatient visits to either department. Of the 83, 5 were lost to follow up. All the 5 were from the North Eastern region of the country. Attempts to contact them through post was unsuccessful. The analysis was undertaken in the remaining 78 who had six months of follow up. It compares well with the studies done on outcome in lupus nephritis. Study done in our centre by Abraham et al and published in ’99 was done on 29 patients with class IV lupus with a follow up of 5 years. Other studies from the West36,70,71,72,73 had sample size ranging from 34-82. CONCLUSIONS : Seventy percent (55/78) patients of lupus nephritis were treatment responders. Significant predictors of poor outcome were Hypertension, WHO Class IV histology , Creatnine clearance <75ml/min, S.albumin <3.5mg/dl, of which Hypertension was an independent predictor of poor outcome at the end of six months of therapy. Demographic pattern and the clinical presentation of lupus nephritis were in keeping with well established literature from India and elsewhere.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prospective Cohart study ; clinical outcomes ; prognostic factors ; lupus nephritis ; tertiary care centre ; South India.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 15 Feb 2018 17:57
Last Modified: 15 Feb 2018 17:57
URI: http://repository-tnmgrmu.ac.in/id/eprint/5727

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