Clinical comparisons between previously diagnosed SLE and newly diagnosed SLE by kidney biopsy
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RIGINAL RESEARCH
Autoimmunity Highlights Open Access
Clinical comparisons between previously diagnosed SLE and newly diagnosed SLE by kidney biopsy Pantipa Tonsawan and Kittisak Sawanyawisuth*
Abstract Background: Lupus nephritis is a type of major organ involvement in systemic lupus erythematosus (SLE) patients that leads to higher rates of morbidity and mortality and may present initially in 28% of SLE patients. However, there are limited data available on clinical differences or predictors for biopsy-proven lupus nephritis in established versus newly diagnosed SLE cases. Methods: Adult patients undergoing kidney biopsy for the first time with a diagnosis of lupus nephritis were eligible for inclusion. Patients were categorized into two groups: those with previously diagnosed SLE and those with newly diagnosed SLE by kidney biopsy. Factors associated with newly diagnosed SLE were determined using logistic regression analysis. Results: There were 68 patients diagnosed with lupus nephritis by kidney biopsy. Of those, 31 cases (45.58%) were newly diagnosed. The newly diagnosed SLE group was significantly older (36.87 vs 30.95 years) and had a lower proportion of females (74.19% vs 91.89%) than the previously diagnosed group. A new-onset hypertension was the only factor independently associated with newly diagnosed SLE by kidney biopsy. The adjusted odds ratio (95% CI) was 5.152 (1.046, 25.363). Conclusions: Nearly half of the biopsy-proven lupus nephritis cases in this study were patients with newly diagnosed SLE. Patients with previously diagnosed SLE and newly diagnosed SLE by kidney biopsy had clinical differences. Keywords: Hypertension, Systemic lupus erythematosus, Diagnosis Introduction Systemic lupus erythematosus (SLE) is an autoimmune disease that may involve several organs. Renal involvement or lupus nephritis affects approximately 50% of SLE patients [1] and is significantly related with mortality (adjusted hazard ratio of 1.65 with 95% CI of 1.03, 2.66) [2]. Additionally, end-stage renal disease may develop in 10% of SLE patients with renal involvement [3].
*Correspondence: [email protected] Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
Lupus nephritis has varying clinical presentations and outcomes, ranging from asymptomatic urine abnormalities to rapid decline in kidney function. Clinical renal parameters for active lupus nephritis in established SLE patients can be evaluated by urinalysis and serum creatinine measurement [1]. Previous studies found that the rate of lupus nephritis increased from 16 to 28% in 10 years and it increased from 32 to 47% in nine years [4–6]. Evidence of proteinuria with or without active urine sediments/cellular casts or unexplained serum creatinine values may indicate lupus nephritis in patients with previously diagnosed SLE. However, kidney biopsy remains the gold standard for diagnosis [1]. Twenty-eight percent of young patients with SLE may present with
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