Home > Review Articles > Ethnic, clinical and immunological factors in systemic lupus erythematosus and the development of lupus nephritis: results from a multi-ethnic New Zealand cohort

Ethnic, clinical and immunological factors in systemic lupus erythematosus and the development of lupus nephritis: results from a multi-ethnic New Zealand cohort

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Authors:
Summary:

These researchers sought to determine risk factors for lupus nephritis including clinical, laboratory, and ethnic factors in a cohort of lupus patients from two teaching hospitals in Auckland, New Zealand, after attending as either an inpatient, or a rheumatology outpatient between 2000 and 2005. 170 patients met American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria. Clinical, laboratory, and ethnic data were gathered from the patient notes. Twenty-four patients had lupus nephritis (LN) at diagnosis and 32 patients developed LN after diagnosis. Significant associations were observed between LN and the following variables; serositis, cutaneous vasculitis, anaemia, elevated CRP at >6 months after diagnosis, and hypocomplementaemia at >6 months after diagnosis. Patients with high doublestranded DNA (>5 x normal) were significantly more likely to develop type IV LN. Forty-one percent of patients were Caucasian, 12% Mäori, 23% Pacific People, 16% Asian, 6% Indian. The risk for developing LN was higher for Mäori patients with SLE (odds ratio [OR] 8.47), and Pacific People (OR 3.11). Independent risk factors for developing LN after SLE diagnosis included anaemia at presentation (hazard ratio [HR] 3.2) and a low complement at >6 months (HR 3.4).

Comment:
SLE is due to an overactive immune system which can cause chronic inflammation in many of the body’s tissues including skin (causing rash), joints (causing arthritis), and lungs. One important complication of the disorder is kidney disease (or lupus nephritis LN) which can cause fluid retention, high blood pressure, and sometimes kidney failure requiring dialysis. I was recently commenting to a colleague that I am seeing more SLE-related kidney disease in Mäori patients, whänau and friends. This study seems to confirm this. In a group of patients with SLE at Middlemore, Mäori with SLE were 8 times more likely to develop LN than the Caucasians with SLE. Early diagnosis of SLE and management, including renal care, are therefore crucial for Mäori. Health providers and individuals/whänau should have a high index of suspicion for SLE when any of 11 criteria (including malar rash, arthritis, kidney abnormalities, etc.) are present.
Reference: Lupus. 2007;16:830-7
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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