Abstract

Systemic lupus erythematosus (SLE) is a clinically heterogeneous multi-system disease, that is characterised by the presence of autoantibodies directed against nuclear antigens. The most common manifestations include rash, arthritis, fatigue, but also anaemia, thrombocytopenia, nephritis and neurologic symptoms. Despite enormous improvements in prognosis since the introduction of immunosuppressive drugs, SLE continues to have a significant impact on the mortality and morbidity of those affected.

The aim of this project was to understand the prevalence, morbidity and outcome associated with lupus nephritis at our auto-immunity diseases centre. Clinical records of 128 patients treated between January 1993 and December 2016 were read, and national registry of Auto-immune diseases was consulted in order to characterise the Lupus cohort. Treatment was assessed and pre and post treatment biopsies were reviewed by WHO classification.

From all 137 patients assessed, average age was 49, with 93% of all patients being females. The most frequent clinical criteria were malar rash in 72%, arthritis in 51%, hematologic disturbances in 43%, from which the most frequent was lymphopenia. Among all patients, 21.2% (n=29) had clinical and histologic diagnostic criteria for lupus nephritis, with mean age at diagnosis of 34 years old (from 17 to 71). From all biopsies performed, 48% were classified as grade IV OMS. All patients were treated with glucocorticoids, and 74% performed induction therapy with Protocol Euro-Lupus, followed by mycophenolate mofetil. ACE inhibitors were used in 95,2% of all patients. Only two patients worsened and interchanged nephritis class, with one patient achieving kidney failure.

This was an important review for our centre, since our patients presented an elevated proportion of Lupus Nephritis, at a very young age.