CLINICAL RENAL INVOLVEMENT IN AFRO-CARIBBEAN LUPUS PATIENTS

This study reports the severity of clinical lupus nephritis (LN), defi ned as the sustained presence of proteinuria and/or cellular casts, in a group of 68 newly diagnosed patients with systemic lupus.erythemato sus (SLE) in Curacao. Fifty-four patients (78%) developed clinical sig ns of LN, of whom 31 (54%) had clinical LN at the time of SLE diagnosi s. The probability of developing clinical LN reached 80% in the first 3 years after SLE diagnosis and hardly increased later. No clinical or serological differences existed at the time of SLE diagnosis or at on set of LN between patients with early-or late-onset LN. Survival in pa tients without LN was 100% at 5 years, while for patients with clinica l LN these rates at 1 and 5 years were 91% and 59%, respectively (P = 0.0001); male LN patients had a worse prognosis than females (P = 0.01 2), while time of LN onset did not influence survival. Six patients (1 1%) developed end-stage renal failure; all were female, rive had early LN and one had late-onset LN (P = 0.17). Renal survival was 97% and 8 0% at 1 and 5 years, with decreased rates for patients with nephrotic- range proteinuria (P = 0.02). Hypertension was present in 13% of LN pa tients, but had no influence on patient or renal survival. Thus, clini cal LN was a frequent complication, which carried a poor prognosis in these Afro-Caribbean lupus patients.