What Is The Life Expectancy Of Lupus Nephritis?
Lupus nephritis is an important cause of morbidity and mortality in patients with (systemic lupus erythematosus) SLE, which has a direct impact on the survival of these patients. The use of an aggressive immunosuppressive treatment has improved renal and patient life expectancy. The objectives of this immunosuppressive therapy are the obtaining of an early remission, avoiding the appearance of exacerbations and the progression to chronic renal failure with the minimum possible toxicity.
Systemic lupus erythematosus (SLE) is an autoimmune and multisystemic disease, mainly affects young women; however, 10-20% of patients debut in childhood. It is one of the most frequent rheumatic diseases in childhood. Research reveals that the age of onset of the disease can modify the clinical expression of the disease.
International studies of systemic lupus erythematosus in children show that survival has been improving in a progressive form. In the 50´s and 60´s, 5-year rates were reported between 17.5% and 69% and, in the last 6 years, up to 100%.
The factors that have contributed to this progression are diverse, such as an earlier recognition of the disease, careful use of steroids, more aggressive treatments such as intravenous cyclophosphamide, use of new immunosuppressive drugs, provision of better support care in therapy intensive, more effective treatments for cardiovascular disease and arterial hypertension, availability of dialysis and kidney transplant, etc.
On the other hand, when there is an augmentation in the hope of life in patients with SLE (increase in 5-year survival) secondary complications arise to the chronicity of the disease and treatment, such as hypertension, growth retardation, chronic lung disease, gonadal alterations, and kidney damage.
The SLE that begins in childhood and adolescence has a worse prognosis, compared to that of beginning in adulthood. In general, children have a more active disease at the beginning and during the follow-up.
In addition, they have a higher incidence of kidney damage that progresses rapidly, with an incidence of kidney disease of 80% vs 53% in children, compared to what happens in adults. This explains the use of more aggressive treatments and the greater cumulative damage associated with high doses of steroids in this age group. The prognosis improves when more aggressive treatments are rationally used.
About Lupus Nephritis
Nephropathy is a frequent and serious manifestation of systemic lupus erythematosus (SLE). It usually develops during the first five years after diagnosis and its prevalence is 60% in adults and 80% in children with Systemic Erythematous Lupus. In addition, it has a direct impact on the survival of lupus patients. However, thanks to early diagnosis, therapeutic advances and the prevention of complications resulting from treatment, the survival of patients with lupus nephritis (LN) has improved in the last 40 years. While the decade of the fifties, the five-year survival rate in patients with LN was close to 0%, in the nineties the survival was from 83% to 92% at five years and from 74% to 84% at ten years. On the other hand, between 10% and 27% of patients with lupus nephritis, particularly those with proliferative glomerulonephritis, eventually develop chronic renal failure (CRF) after five to ten years of diagnosis.
Although survival has improved dramatically in patients with focal and diffuse proliferative LN, its standard treatment established by the National Institutes of Health (NIH) has been associated with various adverse effects, mainly the development of neoplasms, infections and premature gonadal failure. However, the new therapies are encouraging because they have a similar or greater efficacy and less toxicity. The management of focal proliferative NL (class III), diffuse (class IV) and membranous associated with class III lesions (Vc) or Class IV (Vd) is the same since both have a similar prognosis and consists of two phases. The first, or induction of remission, whose objective is the remission of the renal inflammatory process and prevents progression to chronicity. The second phase is the maintenance of remission, which aims to prevent the appearance of new renal exacerbations. The renal remission is defined as the stabilization or improvement in renal function, the presence of a urinary-inactive sediment, proteinuria <1 g/day and normalization (ideally) of the C3 complement for at least six months.
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