Abstract
The aim of this article is to study the prevalence, clinicolaboratory features, WHO histological types, therapy and renal outcome of lupus nephritis (LN) in Saudi Arabia. During the 27-year-period (1980–2006), 299 (47.9%) cases of LN were identified among the 624 cases of systemic lupus erythematosus (SLE) follow-up at King Khalid University Hospital, Riyadh. The female:male ratio in LN was 8.3:1, with a mean age of 32 years and a mean age of onset of 23 years. The WHO renal histological types were; Class I (1%), Class II (18.1%), Class III (10%), Class IV (37.1%), Class V (11.7%), and Class VI (2.7%). Azathioprine was given to 43.1% and pulse cyclophosphamide to 65.6% in combination with other drugs. Remission was seen in 226 (75.6%) patients, renal flares in 14 (4.7%), end stage renal disease (ESRD) in 27 (9.0%), death in 18 (6.0%), and 14 (4.7%) lost follow-up. The 5- and 10-year patient survival rates in our whole LN cohort by Kaplan–Meier analysis were 96% and 95%, respectively. The survival did not differ significantly in different LN classes nor did it differ significantly during the three periods of presentation (1980–1990, 1991–2000, and 2001–2006;
P
> 0.05). The risk factors for poor survival were found to be older age at onset (>50-years age;
P
= 0.034), ESRD (
P
= 0.000), and low C3 (
P
= 0.022). The risk factors for progression to ESRD were older age at onset (>50-years age;
P
= 0.037), hypertension (
P
= 0.009), elevated serum creatinine (
P
= 0.000), and proliferative LN (Classes III, IV;
P
= 0.013,
P
= 0.039). Different treatment modalities did not have significant effect on survival in the whole LN cohort (
P
= >0.05). However, pulse cyclophosphamide favored remission in Classes II, III, IV, and V (
P
= 0.023). The main causes of death were renal failure (50%) and infections (44.4%).