A descriptive study of the factors associated with damage in Malaysian patients with lupus nephritis

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Abstract

Introduction: Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE). Objective: The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients. Methods: Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN. Results: A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40%) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies (p<0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage (p<0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage. Conclusion: Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage. Lupus (2014) 23, 436-442.

Original languageEnglish
Pages (from-to)436-442
Number of pages7
JournalLupus
Volume23
Issue number4
DOIs
Publication statusPublished - 2014

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Lupus Nephritis
Hydroxychloroquine
Prednisolone
Systemic Lupus Erythematosus
Regression Analysis
Kidney
Antiphospholipid Syndrome
Nephrology
Malaysia
Sclerosis
Medical Records
Biopsy

Keywords

  • Antiphospholipid syndrome
  • lupus nephritis
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology
  • Medicine(all)

Cite this

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title = "A descriptive study of the factors associated with damage in Malaysian patients with lupus nephritis",
abstract = "Introduction: Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE). Objective: The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients. Methods: Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN. Results: A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40{\%}) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies (p<0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage (p<0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage. Conclusion: Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage. Lupus (2014) 23, 436-442.",
keywords = "Antiphospholipid syndrome, lupus nephritis, systemic lupus erythematosus",
author = "Shaharir, {Syahrul Sazliyana} and {Abdul Gafor}, {Abdul Halim} and {Mohamed Said}, {Mohd Shahrir} and Kong, {N. C T}",
year = "2014",
doi = "10.1177/0961203313518624",
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pages = "436--442",
journal = "Lupus",
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T1 - A descriptive study of the factors associated with damage in Malaysian patients with lupus nephritis

AU - Shaharir, Syahrul Sazliyana

AU - Abdul Gafor, Abdul Halim

AU - Mohamed Said, Mohd Shahrir

AU - Kong, N. C T

PY - 2014

Y1 - 2014

N2 - Introduction: Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE). Objective: The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients. Methods: Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN. Results: A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40%) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies (p<0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage (p<0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage. Conclusion: Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage. Lupus (2014) 23, 436-442.

AB - Introduction: Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE). Objective: The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients. Methods: Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN. Results: A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40%) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies (p<0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage (p<0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage. Conclusion: Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage. Lupus (2014) 23, 436-442.

KW - Antiphospholipid syndrome

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