Analysis of clinical and histological features of late onset lupus nephritis

Abstract

Objective To compare the clinical and histological characteristics between elderly lupus nephritis (LN) patients and adult LN patients. Methods Patients diagnosed with LN from January 2011 to October 2016 at Fuzong Medical Hospital were enrolled in this retrospective study. Recruited patients were assigned into two groups according to age: the elderly-onset group (aged over 60, n=25) and the adult-onset group (aged below 60, n=50). Clinical features, laboratory manifestations, histological data and treatment responses were analyzed and compared. Results The average ages at the onset of systemic lupus erythematosus (SLE) in the elderly-onset group and the adult-onset group were (62.2±3.1 )years and (33.2±10.0) years (t=18.4, P=0.000), respectively. The female to male ratio was lower in the elderly group compared with that in the adult group (1.3∶1.0 vs. 5.3∶1.0, χ2=6.908, P=0.009). The prevalence of hypertension in the elderly-onset group was much higher than that in the adult-onset group (χ2=9.375, P=0.002). Also, elderly patients showed significantly higher serum creatinine levels (t=80.644, P=0.000) and lower rates of positive anti-dsDNA (χ2=6.304, P=0.012). Additionally, elderly-onset individuals were correlated with higher scores of glomerular sclerosis (80%, χ2=14.109, P=0.000), fibrous crescents (36%, χ2=9.040, P=0.003), tubular atrophy (92%, χ2=7.440, P=0.006), interstitial fibrosis (92%, χ2=7.440, P=0.006) and chronicity index (3.4±1.9, t=3.648, P=0.000), compared with the adult-onset group. Conclusions There are clinical and histological differences between elderly and adult LN patients. LN in the elderly is characterized by a low female to male ratio, a low prevalence of positive anti-dsDNA, high blood pressure, severe kidney injury, and chronic lesions in renal pathology. Key words: Lupus nephritis; Pathology; Clinical features