Cardiovascular risk factors and the long-term outcome of lupus nephritis

We evaluated cardiovascular risk factors, morbidity and mortality in patien ts with lupus nephritis (LN). We prospectively studied 70 consecutive patie nts with LN, and 70 age- and sex-matched controls with systemic lupus eryth ematosus (SLE) but no evidence of nephropathy, from 1988 to 1998. Patients were evaluated at entry for hypertension, diabetes, hyperlipidaemia, smokin g, menopause and antiphospholipid syndrome. The LN patients (64 women, 6 me n) had a mean age of 35 years (SE 1.7, range 11-67). During the 10 years, 1 5 (21%) LN patients and 18 (25%) of the controls were lost to follow-up. Co mpared with controls, LN patients had a higher prevalence of hyperlipidaemi a (44% vs. 2%, p < 0.001), hypertension (44% vs. 9%, p < 0.001) and antipho spholipid antibodies (45% vs. 22%, p = 0.01) at study onset. At the last vi sit, 37 (67%) LN patients had normal plasma creatinine, 13 (24%) had renal failure and only five (9%) end-stage renal failure. Hyperlipidaemia (78% vs . 27%, p < 0.001) and hypertension (67% vs. 32%, p = 0.01) at study onset w ere associated with development of renal failure. Nine LN patients and one control died (16% vs. 2%, p = 0.02). These patients showed more antiphospho lipid syndrome (56% vs. 17%, p = 0.03) and hyperlipidaemia (78% vs. 37%, p = 0.03) at study onset. The main causes of death in LN patients were vascul ar complications (cardiovascular or cerebrovascular events) in five patient s (four of whom had antiphospholipid antibodies) and sepsis in three.