Presentation (CTI)

OBJECTIVES: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE) that significantly impacts patient morbidity and mortality. The current systematic literature review (SLR) aims to understand the SLE progression to LN focusing on key characteristics of LN.
METHODS: This SLR was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using key electronic databases such as Embase^® and Medline^® to identify relevant evidence from the last 10 years.
RESULTS: 24 of the total 26 included studies were retrospective or prospective observational in nature while two were cross-sectional surveys. The sample size of the SLE patients ranged from 53 to 25,009. The majority of the evidence was from Asia (N=11), North/Latin America (N=7), and Europe (N=3). Globally, the prevalence of LN among SLE patients ranged from a minimum of 9.6% (India) to 65% (South Africa). The highest rates of LN were observed in North/Latin America ranging from 24.1% to 59% with the majority of the events developing in the initial 2-3 years of diagnosis. The cumulative incidence of LN in the US ranged from 6% at 1 year to 34.4% at 15 years. A significant predominance of young, male, black, and Hispanic population was observed across the LN patients with the majority (>70%) presenting Class IV and V lesions. Low socioeconomic status was associated with significantly higher rates of LN with dialysis being the costliest component. LN was associated with >2-fold increased risk of mortality and 1.5 times more likely to accrue any organ damage as compared to non-LN SLE patients.
CONCLUSIONS: This review highlights the substantial risk of developing LN related morbidities amongst patients with SLE. Despite advancements in SLE treatment in recent years, LN remains a common complication that requires early detection and timely intervention to improve patient outcomes.