Association between clinicopathological factors and renal outcomes in lupus nephritis with hyperuricemia: a retrospective cohort study, 2008–2022
Abstract
Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with frequent renal involvement. Lupus nephritis (LN) is the most common renal manifestation and is associated with high morbidity. Hyperuricemia (HU) has been controversially linked to worse renal outcomes such as impaired kidney function, increased serum creatinine, need for renal replacement therapy, and mortality.
Objective: To identify clinical, laboratory, and histopathological factors associated with renal outcomes, mortality, and clinicopathological patterns in patients with LN, with and without HU, between 2008 and 2022.
Methods: Retrospective cohort of patients ≥18 years with SLE and LN confirmed by renal biopsy, treated at a referral center in Barranquilla, Colombia. Patients with drug-induced SLE, pre-existing chronic kidney disease, kidney transplant, or malignancy were excluded. Clinicopathological patterns, renal outcomes (dialysis or transplant), and mortality were analyzed. Cox regression and ordinal logistic regression models were applied.
Results: Thirty-six patients (75% women, mean age 34 years) were followed for 14 years. Annual HU incidence was 3.57 %. Mortality was 13.9 %, dialysis requirement 27.8 %, and transplant 11.1 %. HU was not significantly associated with mortality (HR 0.79; 95%CI 0.35–1.81; p=0.58) or renal outcomes but was strongly associated with ISN class IV and/or V (OR 24.6; 95% CI 2.56–706.6; p=0.018). Diabetes mellitus increased the risk of adverse clinicopathological changes (adjusted HR 9.35; 95%CI 1.33–65.55; p=0.025), while male sex was associated with lower risk of renal outcome (adjusted HR 0.05; 95%CI 0.01–0.92; p=0.044).
Conclusions: HU was associated with advanced histological classes but not with mortality or renal outcomes. DM and sex showed differential associations with clinical evolution. Larger prospective studies with histological follow-up are warranted.
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