Prognostic significance of hypertension at the onset of lupus nephritis in Chinese patients: prevalence and clinical outcomes.

Abstract

The demographic features, and clinical and histological characteristics of lupus nephritis (LN) patients with hypertension in the Chinese population remain unclear. Hence, the clinical characteristics of LN with and without hypertension were retrospectively analyzed. A total of 764 LN patients (53.1%) were hypertensive. These hypertensive patients had higher levels of serum creatinine and blood urea nitrogen, and lower estimated glomerular filtration rates, when compared to their normotensive counterparts (P < 0.05). Furthermore, these hypertensive patients had higher median acuity index and chronicity index scores, when compared to normotensives (P < 0.001). In terms of histology, hypertensive patients were more likely to develop glomerular sclerosis, thickened glomerular capillary loops, or crescent formations, and had more severe endothelial cell proliferation, when compared to normotensive patients (P < 0.001). Hypertensive patients also had a higher percentage for more severe tubular atrophy, interstitial inflammatory cell infiltration and interstitial fibrosis (P < 0.001). Compared with normotensive patients, hypertensive patients exhibited a significant decline in survival time and rate for all end points (P < 0.01). The presence of hypertension was an independent predictor of mortality (P = 0.009), ESRD (P = 0.026), and doubling of serum creatinine (P = 0.017). In conclusion, hypertension is associated with poor clinical and renal outcome in LN patients. The monitoring and control of hypertension should be considered an important clinical goal in the treatment of LN patients.