Clinical and histopathological features of lupus nephritis and the risk of long-term kidney outcomes in Indonesia
ObjectiveRace and region-specific variables influence lupus nephritis clinical features and prognosis. We examined the clinicopathological presentation and long-term kidney outcomes of lupus nephritis in Indonesia.MethodsThis was a retrospective cohort study conducted from 1 January 2011 to 31 Decem...
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Frontiers Media S.A.
2025-06-01
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| author | Ni Made Hustrini Ni Made Hustrini Endang Susalit Monik Ediana Miranda Meilania Saraswati Y. K. Onno Teng Merel van Diepen Joris I. Rotmans |
| author_facet | Ni Made Hustrini Ni Made Hustrini Endang Susalit Monik Ediana Miranda Meilania Saraswati Y. K. Onno Teng Merel van Diepen Joris I. Rotmans |
| author_sort | Ni Made Hustrini |
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| description | ObjectiveRace and region-specific variables influence lupus nephritis clinical features and prognosis. We examined the clinicopathological presentation and long-term kidney outcomes of lupus nephritis in Indonesia.MethodsThis was a retrospective cohort study conducted from 1 January 2011 to 31 December 2021 on biopsy-proven lupus nephritis patients, corresponding to the International Society of Nephrology/Renal Pathology Society 2018 classification. Patients were followed until death, development of end-stage kidney disease, initiation of kidney replacement therapy, or end of study. The association between lupus nephritis class and kidney outcomes was analyzed using cumulative incidence plots. A linear mixed-model analysis was performed to assess the association between lupus nephritis class and kidney function decline.ResultsThis study included 268 patients, with a mean age of 28.7 + 8.5 years, and 94.8% were female. The main histopathological diagnosis was class IV (39.6%). The prescription rate of renin–angiotensin–aldosterone system (RAAS) inhibitors ranged from 0.5% in class VI to 37.4% in class IV (p = 0.138), while that of hydroxychloroquine usage ranged from 0% in class VI to 37.7% in class IV (p = 0.845). Class IV was associated with higher chronic and active lesions, including global (42.6%, p = 0.073) and segmental (41.1%, p = 0.009) glomerulosclerosis; segmental (43.1%, p < 0.001) and global (74.1%, p = 0.004) endocapillary hypercellularity; and sub-endothelial deposit (59.5%, p = 0.007). Over a median follow-up of 26 (IQR = 6.0–48.0) months, 16.4% of patients died, and 3.7% developed end-stage kidney disease or initiated kidney replacement therapy. Infection, including tuberculosis (9.1%), was the leading cause of death. Class IV was associated with a high mortality risk (HR 1.94, p = 0.028), a lower baseline estimated glomerular filtration rate (eGFR) compared with class I/II (β = −51.3, SE = 12.3, p < 0.001), and a less steep decline or even an increase in eGFR over time (β = 15.7, SE = 7.0, p = 0.026).ConclusionsThis cohort demonstrated a high prevalence of chronic lesions, low use of renin–angiotensin–aldosterone system inhibitors and immunosuppressive medications, and notable mortality. This study highlights the importance of timely detection on kidney involvement in SLE patients, routine use of renin–angiotensin–aldosterone system inhibitors, optimal prescription of immunosuppressive medications, and aggressive screening and prophylactic measures of infectious diseases should be encouraged to improve kidney outcomes in lupus nephritis patients in Indonesia. |
| format | Article |
| id | doaj-art-33102193128e4b54ab5ce8cef4d807fb |
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| language | English |
| publishDate | 2025-06-01 |
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| spelling | doaj-art-33102193128e4b54ab5ce8cef4d807fb2025-08-20T02:10:05ZengFrontiers Media S.A.Frontiers in Lupus2813-69342025-06-01310.3389/flupu.2025.16046441604644Clinical and histopathological features of lupus nephritis and the risk of long-term kidney outcomes in IndonesiaNi Made Hustrini0Ni Made Hustrini1Endang Susalit2Monik Ediana Miranda3Meilania Saraswati4Y. K. Onno Teng5Merel van Diepen6Joris I. Rotmans7Division of Nephrology and Hypertension – Department of Internal Medicine, Faculty of Medicine – Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, IndonesiaDepartment of Internal Medicine, Leiden University Medical Center, Leiden, NetherlandsDivision of Nephrology and Hypertension – Department of Internal Medicine, Faculty of Medicine – Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, IndonesiaDepartment of Pathological Anatomy, Faculty of Medicine – Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, IndonesiaDepartment of Pathological Anatomy, Faculty of Medicine – Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, IndonesiaDepartment of Internal Medicine, Leiden University Medical Center, Leiden, NetherlandsDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden, NetherlandsDepartment of Internal Medicine, Leiden University Medical Center, Leiden, NetherlandsObjectiveRace and region-specific variables influence lupus nephritis clinical features and prognosis. We examined the clinicopathological presentation and long-term kidney outcomes of lupus nephritis in Indonesia.MethodsThis was a retrospective cohort study conducted from 1 January 2011 to 31 December 2021 on biopsy-proven lupus nephritis patients, corresponding to the International Society of Nephrology/Renal Pathology Society 2018 classification. Patients were followed until death, development of end-stage kidney disease, initiation of kidney replacement therapy, or end of study. The association between lupus nephritis class and kidney outcomes was analyzed using cumulative incidence plots. A linear mixed-model analysis was performed to assess the association between lupus nephritis class and kidney function decline.ResultsThis study included 268 patients, with a mean age of 28.7 + 8.5 years, and 94.8% were female. The main histopathological diagnosis was class IV (39.6%). The prescription rate of renin–angiotensin–aldosterone system (RAAS) inhibitors ranged from 0.5% in class VI to 37.4% in class IV (p = 0.138), while that of hydroxychloroquine usage ranged from 0% in class VI to 37.7% in class IV (p = 0.845). Class IV was associated with higher chronic and active lesions, including global (42.6%, p = 0.073) and segmental (41.1%, p = 0.009) glomerulosclerosis; segmental (43.1%, p < 0.001) and global (74.1%, p = 0.004) endocapillary hypercellularity; and sub-endothelial deposit (59.5%, p = 0.007). Over a median follow-up of 26 (IQR = 6.0–48.0) months, 16.4% of patients died, and 3.7% developed end-stage kidney disease or initiated kidney replacement therapy. Infection, including tuberculosis (9.1%), was the leading cause of death. Class IV was associated with a high mortality risk (HR 1.94, p = 0.028), a lower baseline estimated glomerular filtration rate (eGFR) compared with class I/II (β = −51.3, SE = 12.3, p < 0.001), and a less steep decline or even an increase in eGFR over time (β = 15.7, SE = 7.0, p = 0.026).ConclusionsThis cohort demonstrated a high prevalence of chronic lesions, low use of renin–angiotensin–aldosterone system inhibitors and immunosuppressive medications, and notable mortality. This study highlights the importance of timely detection on kidney involvement in SLE patients, routine use of renin–angiotensin–aldosterone system inhibitors, optimal prescription of immunosuppressive medications, and aggressive screening and prophylactic measures of infectious diseases should be encouraged to improve kidney outcomes in lupus nephritis patients in Indonesia.https://www.frontiersin.org/articles/10.3389/flupu.2025.1604644/fulllupus nephritischronic kidney diseasekidney biopsylong-term outcomedisease progression |
| spellingShingle | Ni Made Hustrini Ni Made Hustrini Endang Susalit Monik Ediana Miranda Meilania Saraswati Y. K. Onno Teng Merel van Diepen Joris I. Rotmans Clinical and histopathological features of lupus nephritis and the risk of long-term kidney outcomes in Indonesia Frontiers in Lupus lupus nephritis chronic kidney disease kidney biopsy long-term outcome disease progression |
| title | Clinical and histopathological features of lupus nephritis and the risk of long-term kidney outcomes in Indonesia |
| title_full | Clinical and histopathological features of lupus nephritis and the risk of long-term kidney outcomes in Indonesia |
| title_fullStr | Clinical and histopathological features of lupus nephritis and the risk of long-term kidney outcomes in Indonesia |
| title_full_unstemmed | Clinical and histopathological features of lupus nephritis and the risk of long-term kidney outcomes in Indonesia |
| title_short | Clinical and histopathological features of lupus nephritis and the risk of long-term kidney outcomes in Indonesia |
| title_sort | clinical and histopathological features of lupus nephritis and the risk of long term kidney outcomes in indonesia |
| topic | lupus nephritis chronic kidney disease kidney biopsy long-term outcome disease progression |
| url | https://www.frontiersin.org/articles/10.3389/flupu.2025.1604644/full |
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