Evaluation of Renal Involvement in Systemic Lupus Erythematosus: Clinical Profile and Outcomes of Lupus Nephritis

Original Article

Abstract

Background:  Lupus nephritis (LN) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Disease prognosis is closely related to histological class, and early diagnosis with timely treatment is essential to prevent irreversible renal damage and improve survival outcomes.

Objective: To evaluate the clinical presentation, laboratory findings, histological patterns, treatment response, and predictors of poor renal outcomes in patients with lupus nephritis.

Methods: This retrospective observational cohort study was conducted in the Department of Nephrology at the Institute of Kidney Diseases, Peshawar, from January 2021 to December 2023. Adult patients (≥18 years) diagnosed with LN according to the ISN/RPS classification were included. Data on demographics, clinical features, laboratory findings, and treatment were collected. Renal outcomes were categorized as remission, chronic kidney disease (CKD), or death. Statistical analysis was performed using SPSS version 24.0, with significance set at p < 0.05.

Results:  A total of 100 patients were included, of whom 86% were female. The mean age was 27.4 ± 6.3 years. Class IV lupus nephritis was the most common histological subtype (44%), followed by Class III (27%) and Class V (18%). Most patients presented with proteinuria (92%) and hypertension (53%). Complete or partial remission was achieved in 63% of patients, while 26% progressed to chronic kidney disease and 11% died during follow-up. Elevated baseline serum creatinine (>2.0 mg/dL) and advanced histological class (Class IV/V) were significantly associated with poor renal outcomes (p = 0.002). Early initiation of immunosuppressive therapy was associated with improved renal outcomes (p = 0.01).

Conclusion: Lupus nephritis remains a major determinant of renal outcomes in SLE. Early diagnosis, timely biopsy, appropriate immunosuppressive therapy, and regular follow-up are critical for improving long-term prognosis