Factors Associated with Worsening Renal Outcomes and End Stage Renal Disease in Lupus Nephritis in Saraburi Hospital


  • Sivakorn Nijthaworn
  • Udomsak Udompol


Lupus nephritis, Systemic lupus erythematosus, Renal failure, Chronic kidney disease, ESRD, risk factors


Background: Lupus nephritis (LN) is one of the common manifestations among SLE patients, it manifests mainly with proteinuria, edema, hematuria or renal failure. About 10% of patients developing chronic kidney disease (CKD) and end-stage renal disease (ESRD). The objective of our study was to identify the risk factors associated with worsening renal outcomes and development of ESRD in patients with lupus nephritis.

Methods: We performed a retrospective cohort study of patients who were diagnosed as lupus nephritis by kidney biopsy based on data from medical records in Saraburi hospital for the years 2010-2015. We collected patient’s clinical characteristics, laboratory data, treatment and outcomes. The primary outcome measure was the presence of worsening renal outcomes (doubling of serum creatinine) and ESRD in 3 years after received treatment.  

Results: We identified 397 renal biopsies, of which 83 biopsies confirmed diagnosis of LN. Mean age was 31 years at the time of renal biopsy. The most frequent of histopathological class of LN was class IV (74.7%) followed by class V (14.5%). Patients with histological class IV LN had a significantly lower initial eGFR followed by class III group. The multivariate analysis showed that clinical presentation of nephrito-nephrotic syndrome was the risk factor of both worsening renal outcomes (HR = 6.21, 95%CI = 1.83-21.07, p = 0.003) and development of ESRD (HR = 5.56, 95%CI = 1.23-25.07, p = 0.026). Same as acute kidney injury (AKI), was the risk factor of both outcomes (HR = 4.52, 95%CI = 1.33-15.36, p = 0.016), (HR = 8.84, 95%CI = 1.15-67.98, p = 0.036). In contrast, older age was the factor that slightly decrease the risk of worsening renal outcomes (HR = 0.93, 95%CI = 0.88-0.99, p = 0.021).  

Conclusions: Data from medical records in Saraburi hospital show that the risk factors associated with worsening renal outcomes (doubling serum creatinine) and development of ESRD in 3 years after receive treatment are the clinical presentation of nephrito-nephrotic syndrome and acute kidney injury (AKI) at the presentation.


Cameron JS: Lupus nephritis. J Am Soc Nephrol 1999;10:413–424.

Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejia JC, Aydintug AO, Chwa- linska-Sadowska H, de Ramon E, Fernandez-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR; European Working Party on Systemic Lupus Erythematosus: Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Balti- more) 2003;82:299–308.

Costenbader KH, Desai A, Alarcon GS, Hiraki LT, Shaykevich T, Brookhart MA, Massarotti E, Lu B, Solomon DH, Winkelmayer WC: Trends in the incidence, demographics, and outcomes of end-stage renal disease due to lupus nephritis in the US from 1995 to 2006. Arthritis Rheum 2011;63:1681–1688.

Mok CC: Prognostic factors in lupus nephritis. Lupus 2005;14:39–44.

Mittal B, Rennke H, Singh AK: The role of kidney biopsy in the management of lupus nephritis. Curr Opin Nephrol Hypertens 2005;14:1–8.

Contreras G , Pardo V, Cely C, Borja E, Hurtado A, De La Cuesta C, Iqbal K, Lenz O, Asif A, Nahar N, Leclerq B, Leon C, Schulman I, Ramirez-Seijas F, Paredes A, Cepero A, Khan T, Pachon F, Tozman E, Barreto G, Hoffman D, Almeida Suarez M, Busse JC, Esquenazi M, Esquenazi A, Garcia Mayol L, Garcia Estrada H: Factors associated with poor outcomes in patients with lupus nephritis. Lupus 2005;14:890-895

Korbet SM , Lewis EJ, Schwartz MM, Reichlin M, Evans J, Rohde RD: Factors predictive of outcome in severe lupus nephritis. Lupus Nephritis Collaborative Study Group. AM J Kidney Dis 2000;35:904-914.p

Anadi Mahajan, Justyna Amelio, Kerry Gairy, Gavneet Kaur, Roger A Levy, David Roth, Damon Bass: Systemic lupus erythematosus, lupus nephritis and end-stage renal disease: a pragmatic review mapping disease severity and progression. Lupus 2020;29:1011-1020.

Carreno L, Lopez-Longo FJ, Monteagudo I, Rodriguez-Mahou M, Bascones M, Gonzalez CM, Saint-Cyr C, Lapointe N: Immunological and clinical differences between juvenile and adult onset of systemic lupus erythematosus. Lupus 1999;8:287–292.

Font J, Cervera R, Espinosa G, Pallares L, Ramos-Casals M, Jimenez S, Garcia-Carrasco M, Seisdedos L, Ingelmo M: Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparison with SLE characteristics in adults. Ann Rheum Dis 1998;57:456–459.

Chi Chiu Mok, Anselm Mak, Wai Po Chu, Chi Hung To, Sik Nin Wong: Long-term survival of southern Chinese patients with systemic lupus erythematosus: a prospective study of all age-groups. Medicine 2005;84:218-224.

Sheliza Lalani, Janet Pope, Faye de Leon, Christine Peschken: Clinical features and prognosis of late-onset systemic lupus erythematosus: results from the 1000 faces of lupus study.J Rheumatol 2010;37:38-44

Vozmediano C, Rivera F, López-Gómez JM, Hernández D: Risk factors for renal failure in patients with lupus nephritis: data from the Spanish registry of glomerulonephritis. Nephron Extra 2012;2:269–277.

Soni SS, Gowrishankar S, Adikey GK, Raman A: Sex-based differences in lupus nephritis: a study of 235 Indian patients. J Nephrol 2008;21:570–575.

Resende AL, Titan SM, Barros RT, Woronik V: Worse renal outcome of lupus nephritis in male patients: a case-control study. Lupus 2011;20:561–567.

Reich HN, Gladman DD, Urowitz MB, Bargman JM, Hladunewich MA, Lou W, Fan SC, Su J, Herzenberg AM, Cattran DC, Wither J, Landolt-Marticorena C, Scholey JW, Fortin PR: Persistent proteinuria and dyslipidemia increase the risk of progressive chronic kidney disease in lupus erythematosus. Kidney Int 2011;79:914–920.

Martins L, Rocha G, Rodrigues A, Santos J, Vasconcelos C, Correia J, Farinha F, Almeida I, Barbosa P, Guimaraes S: Lupus nephritis: a retrospective review of 78 cases from a single center. Clin Nephrol 2002;57:114–119.

Al Arfaj AS, Khalil N, Al Saleh S: Lupus nephritis among 624 cases of systemic lupus erythematosus in Riyadh, Saudi Arabia. Rheumatol Int 2009;29:1057–1067.

Najafi CC, Korbet SM, Lewis EJ, Schwartz MM, Reichlin M, Evans J: Significance of histologic patterns of glomerular injury upon long-term prognosis in severe lupus glomerulonephritis. Kidney Int 2001;59:2156–2163.




How to Cite

Nijthaworn, S. ., & Udompol, U. . (2022). Factors Associated with Worsening Renal Outcomes and End Stage Renal Disease in Lupus Nephritis in Saraburi Hospital. Saraburi Hospital Medical Journal, 36(2), 10–22. Retrieved from https://he01.tci-thaijo.org/index.php/SHMJ/article/view/260124



Research Articles