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Abstract
Objective East Asian systemic lupus erythematosus (SLE) is under represented in lupus cohorts outside of East Asia. We asked whether lupus nephritis was more common and more severe in East Asians than in other ethnicities in a large United States SLE cohort.
Methods The Hopkins Lupus Cohort, a longitudinal cohort of 2,802 patients (53.5% Caucasian, 39.2% African-American, 3.2% East Asian) was studied. The SLICC/ACR Damage Index was used to assess renal outcomes.
Results East Asian patients had the same prevalence of lupus nephritis as African-Americans and both were higher than Caucasians. East Asians were not significantly different in the frequency of end stage kidney disease compared with African-Americans (figure 1). East Asians were more likely than Caucasians to have anti-Sm (OR 3.57 (2.24, 5.68), p<0.0001), low C3 (OR 5.69 (3.13, 10.3), p<0.0001) and low C4 (OR 2.30 (1.46, 3.61), p=0.0003). East Asians were more likely than African-Americans to have low C3 (OR 4.41 (2.42, 8.05), p<0.0001) and low C4 (OR 2.07 (1.31, 3.27), p=0.0018). East Asians developed lupus nephritis earlier than Caucasians, but slower than African-Americans (figure 2). Analysis of the first biopsy confirming lupus nephritis showed that East Asians were more likely to have proliferative lupus nephritis (ISN Class IV) and less likely to have membranous lupus nephritis (ISN Class V) compared to Caucasians and African-Americans (p=0.0082 Likelihood test) (figure 3).
Conclusion East Asians living in the United States were more likely to have lupus nephritis than Caucasians. Poor outcomes such as end stage kidney disease occurred at an equal frequency in East Asians as in African-Americans. Lupus nephritis was both more frequent and more severe in East Asians than in African-Americans. The severity of East Asian lupus nephritis in the U.S. has been unrecognized.
East Asian vs African-American or Caucasian – Renal manifestations and outcomes
Time to end stage renal disease by race
Lupus nephritis ISN class of first biopsy by race
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