Materiały źródłowe

• #1 Insights into the Epidemiology and Management of Lupus Nephritis from the U.S. Rheumatologist’s Perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5679458/

  Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that disproportionately affects non-Whites and those in lower socioeconomic groups. This review discusses recent data on the incidence, prevalence, and outcomes of patients with lupus nephritis with a focus on low-income US Medicaid patients. […] The lack of sustained progress in LN outcomes may be due to poor healthcare access for some groups, limited efficacy of current therapies, and/or their adverse effects. […] SLE and LN both occur disproportionately among non-Whites, which is well demonstrated in the heterogeneous population of the US. […] A socioeconomic gradient is apparent in the prevalence of LN, with increased prevalence in poorer geographic areas that persists after adjustment for age, sex, and ethnicity.

• #2

  https://journals.lww.com/cjasn/fulltext/2017/05000/update_on_lupus_nephritis.16.aspx

  SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. […] The prevalence of SLE and the chances of developing lupus nephritis (LN) vary considerably between different regions of the world and different races and ethnicities. […] In the United States, the higher frequency of LN in black populations persists after adjustment for socioeconomic factors. […] Additionally, black and Hispanic SLE patients develop LN earlier, and have worse outcomes than white patients with SLE, including death and ESRD. […] The more aggressive disease course in black individuals might be the result of a higher incidence of diffuse proliferative LN, or the presence of more high-risk features within the same LN histologic class when compared with white individuals. […] LN is a major risk factor for morbidity and mortality in SLE and 10% of patients with LN will develop ESRD. […] The risk of ESRD is higher in certain subsets of LN. […] Patients with LN also have a higher standardized mortality ratio and die earlier than SLE patients without LN. […] Importantly, 10-year survival improves from 46% to 95% if disease remission can be achieved.

• #3 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Approximately 15% to 30% of patients have lupus nephritis at the time of SLE diagnosis, with more patients at risk of developing lupus nephritis over the course of their disease. An estimated 30% to 50% of patients with SLE will later develop lupus nephritis. […] Testing for kidney involvement in patients with SLE is indicated as regular surveillance and at the time of SLE diagnosis or when a disease flare is suspected. […] Guidelines for diagnosing and treating lupus nephritis include the following: The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the management of lupus nephritis.

• #4 Epidemiology, pathophysiology and management of Lupus Nephritis – Conquest Health

  https://conquest.health/epidemiology-pathophysiology-and-management-of-lupus-nephritis/

  Lupus nephritis (LN) is present in approximately 25% of patients at the time of diagnosis and eventually develops in up to 60% of adults and 80% of children. […] Lupus nephritis (LN) occurs in ~50% of patients with SLE. LN typically develops early in the disease course, generally within the first 6 to 36 months, and maybe present at initial diagnosis. The incidence of LN is higher in Asians (55%), followed by Africans (51%), and Hispanics(43%) when compared with Caucasians (14%). […] For SLE patients, LN continues to be a major cause of morbidity and mortality. The majority of patients get LN during their prime years of life, which harms their livelihoods and families, as well as society as a whole.

• #5 Lupus Nephritis | Diagnosis & Disease Information

  https://www.rheumatologyadvisor.com/ddi/lupus-nephritis/

  Approximately 15% to 30% of patients have lupus nephritis at the time of SLE diagnosis, with more patients at risk of developing lupus nephritis over the course of their disease. An estimated 30% to 50% of patients with SLE will later develop lupus nephritis. […] Testing for kidney involvement in patients with SLE is indicated as regular surveillance and at the time of SLE diagnosis or when a disease flare is suspected. […] Guidelines for diagnosing and treating lupus nephritis include the following: The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the management of lupus nephritis.

• #6 Presentation and Prevalence of Lupus Nephritis

  https://www.ajmc.com/view/presentation-and-prevalence-of-lupus-nephritis

  Ellen Ginzler, MD, MPH, and German Hernandez, MD, FASN, FACP, provide insight into the clinical presentation of patients with lupus nephritis, the progression of systemic lupus erythematosus to lupus nephritis, and the prevalence of this rare disease. […] How often patients with lupus progress to lupus nephritis can vary depending on the different populations. It can be as low as 15% or as high as 45% of patients with lupus. Certain racial and ethnic minority groups tend to have a higher burden of lupus nephritis, but in general, about 40% to 45% of patients with lupus can have involvement with lupus nephritis. […] Theres some disagreement about how common lupus is in the United States. It may depend on whether you use a strict definition based on criteria. […] Organizations like the Lupus Foundation of America will give you a figure of over a million cases of lupus in the United States. But other studies that use more strict definitions and careful attention to how the diagnosis is made will more likely come up with a figure of 300,000 to 350,000 cases of lupus in the United States. That would mean that the prevalence of lupus nephritis is probably in the neighborhood of under 200,000 at any time, making it an orphan disease. That also depends upon geographic distribution. There seems to be more lupus and lupus nephritis in urban areas, or areas where patients are less economically advantaged. Its more common in individuals of color. Its much more common in Black, Hispanic, and even Asian individuals than in Caucasians.

• #7 Lupus Nephritis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117507/2.3/Lupus_Nephritis

  Peak incidence of SLE is 15 to 45 years of age. Mean age of diagnosis is between 25 and 30 years of age. […] The lifetime incidence of lupus nephritis (LN) in patients with SLE is 20-60%. […] Predominant sex: female male (10:1). […] Once SLE develops, LN affects both genders equally; it is more severe in children and men and less severe in older adults. […] More common in African American and Asian populations. […] Up to 60% of SLE patients develop LN over time; 25-50% of SLE patients have nephritis as the initial presentation. […] LN is more common and more severe in children: 60-80% of children have LN at or soon after SLE onset.

• #8 Lupus Nephritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/330369-overview

  In a multi-ethnic international cohort of patients enrolled within 15 months (mean, 6 months) after SLE diagnosis and assessed annually, lupus nephritis occurred in 700 of 1827 patients (38.3%). Lupus nephritis was frequently the initial presentation of SLE; it was identified at enrollment in 80.9% of cases. Patients with nephritis were younger, more frequently men and of African, Asian, and Hispanic race/ethnicity. […] In a study of a large Spanish registry, lupus nephritis was histologically confirmed in 1092 of 3575 patients with SLE (30.5%). The mean age at lupus nephritis diagnosis was 28.4 years. The risk for lupus nephritis development was significantly higher in men, in younger individuals, and in Hispanics. Patients receiving antimalarials had a significantly lower risk of developing lupus nephritis.

• #9 Incidence, Prevalence, and Mortality of Lupus Nephritis: A Population-Based Study Over Four Decades—The Lupus Midwest Network (LUMEN)

  https://stacks.cdc.gov/view/cdc/126397

  Objectives There is paucity of population-based studies investigating the epidemiology of lupus nephritis (LN) in the US and long-term secular trends of the disease and its outcomes. We aimed to examine the epidemiology of LN in a well-defined eight-county region in the US. […] Average annual LN incidence between 1976 and 2018 was 1 per 100,000 population (95%CI 0.8-1.3) and highest in the 30-39 age group. […] Estimated LN prevalence increased from 16.8 in 1985 to 21.2 per 100,000 in 2015. […] The incidence and prevalence of LN in this area increased in the last four decades. LN patients have poor outcomes with high rates of ESRD and mortality rates six times that of the general population.

• #10 Incidence, Prevalence, and Mortality of Lupus Nephritis: A Population-Based Study Over Four Decades—The Lupus Midwest Network (LUMEN)

  https://stacks.cdc.gov/view/cdc/126397

  Objectives There is paucity of population-based studies investigating the epidemiology of lupus nephritis (LN) in the US and long-term secular trends of the disease and its outcomes. We aimed to examine the epidemiology of LN in a well-defined eight-county region in the US. […] Average annual LN incidence between 1976 and 2018 was 1 per 100,000 population (95%CI 0.8-1.3) and highest in the 30-39 age group. […] Estimated LN prevalence increased from 16.8 in 1985 to 21.2 per 100,000 in 2015. […] The incidence and prevalence of LN in this area increased in the last four decades. LN patients have poor outcomes with high rates of ESRD and mortality rates six times that of the general population.

• #11 Contemporary Incidence of Lupus Nephritis Among Patients with Systemic Lupus Erythematosus in the United States – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/contemporary-incidence-of-lupus-nephritis-among-patients-with-systemic-lupus-erythematosus-in-the-united-states/

  Contemporary Incidence of Lupus Nephritis Among Patients with Systemic Lupus Erythematosus in the United States […] Lupus nephritis is a leading cause of morbidity in patients with systemic lupus erythematosus (SLE). […] We sought to determine the incidence of lupus nephritis (LN) in a contemporary United States SLE cohort. […] A total of 6,025 patients developed lupus nephritis during a mean of 50.2 months (SD 40.3) follow up, and 4,175 (69.3%) met the stricter secondary definition. […] The overall cumulative incidence of LN was 24.9% at 5 years, 30.1% at 10 years, and 34.4% at 15 years of follow up. […] The incidence of LN was higher among men with SLE (44.7% vs 28.6% of women at 10 years). […] In this contemporary, multi-center, EHR-based SLE inception cohort, one third of patients with SLE developed LN after 15 years of follow-up, and just over half of all cases were identified as an early manifestation around the time of SLE diagnosis. […] The incidence of LN was higher in non-white individuals and in men with SLE. […] Despite improved treatment for SLE in recent years, LN remains a frequent manifestation among patients with SLE that benefits from early identification and treatment.

• #12

  https://www.roche.com/solutions/focus-areas/kidney-diseases/lupus-nephritis

  Lupus nephritis is a potentially life-threatening manifestation of systemic lupus erythematosus, an autoimmune disease that commonly affects the kidneys. It affects approximately 1.7 million people worldwide and has a profound impact on their lives and outlook, with up to a third of people progressing to end-stage kidney disease within 10 years, where the only options are dialysis or transplant. […] Currently, there is no cure.

• #13 Lupus Nephritis – Epidemiology Forecast – 2032

  https://www.researchandmarkets.com/reports/5524425/lupus-nephritis-epidemiology-forecast-2032?srsltid=AfmBOoo1CLKfT_OL64wkegWM9jcjKpB1fTYzRXf-2ksQrLSbypeieYt7

  Lupus nephritis is a severe, organ-threatening manifestation of systemic lupus erythematosus (SLE), developed in 40-60% of patients with SLE. Signs of lupus nephritis include hematuria (blood in the urine) and proteinuria (protein in the urine). Lupus nephritis is more common in women and occurs in patients aged 20-40. […] In 2022, the total prevalent cases of lupus nephritis were highest in the US among the 7MM, accounting for approximately 144,000 cases, expected to increase by 2032. […] The total diagnosed prevalent cases of SLE in the 7MM comprised approximately 657,000 cases in 2022 and are projected to increase during the forecasted period. […] The United States contributed to the largest prevalent cases of lupus nephritis, accounting for approximately 50% of the 7MM in 2022. Whereas EU4 the UK, and Japan accounted for around 36% and 14% of the total population share, respectively, in 2022. […] The total diagnosed and treated cases of lupus nephritis in the US comprised nearly 130,000 cases in 2022. […] Among EU4 and the UK, the UK accounted for the largest number of lupus nephritis cases, followed by Germany, whereas France accounted for the lowest number of cases in 2022.

• #14 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  There is a higher incidence of LN among patients with SLE in the United States as compared with Europe, which may in part reflect racial and ethnic differences. […] The incidence of LN is higher in Black patients with SLE (34 to 51 percent), Hispanic patients (31 to 43 percent), and Asian patients (33 to 55 percent) than it is in White patients (14 to 23 percent). […] Black patients and Hispanic patients also tend to present with more severe underlying histopathology, higher serum creatinine concentrations, and more proteinuria than White patients. […] In addition, Black patients, Hispanic patients, and those living in poverty have a worse prognosis than White patients and those with a higher socioeconomic status. […] However, the higher frequency of LN in Black populations persists even after correction for socioeconomic factors.

• #15 Lupus Nephritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/330369-overview

  In a multi-ethnic international cohort of patients enrolled within 15 months (mean, 6 months) after SLE diagnosis and assessed annually, lupus nephritis occurred in 700 of 1827 patients (38.3%). Lupus nephritis was frequently the initial presentation of SLE; it was identified at enrollment in 80.9% of cases. Patients with nephritis were younger, more frequently men and of African, Asian, and Hispanic race/ethnicity. […] In a study of a large Spanish registry, lupus nephritis was histologically confirmed in 1092 of 3575 patients with SLE (30.5%). The mean age at lupus nephritis diagnosis was 28.4 years. The risk for lupus nephritis development was significantly higher in men, in younger individuals, and in Hispanics. Patients receiving antimalarials had a significantly lower risk of developing lupus nephritis.

• #16 Lupus Nephritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/330369-overview

  Most patients with SLE develop lupus nephritis early in their disease course. SLE is more common among women in the third decade of life, and lupus nephritis typically occurs in patients aged 20-40 years. […] Because the overall prevalence of SLE is higher in females (ie, female-to-male ratio of 9:1), lupus nephritis is also more common in females; however, clinical renal disease has a worse prognosis and is more common in males with SLE. […] SLE is more common in African Americans and Asians than in white people, with the highest prevalence in Caribbean people. The prevalence of lupus nephritis is much higher in Asians than in Whites with SLE, but the 10-year renal outcome and renal survival rate appear to be better in Asians. […] Particularly severe lupus nephritis may be more common in African Americans and Asians than in other ethnic groups.

• #17 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  There is a higher incidence of LN among patients with SLE in the United States as compared with Europe, which may in part reflect racial and ethnic differences. […] The incidence of LN is higher in Black patients with SLE (34 to 51 percent), Hispanic patients (31 to 43 percent), and Asian patients (33 to 55 percent) than it is in White patients (14 to 23 percent). […] Black patients and Hispanic patients also tend to present with more severe underlying histopathology, higher serum creatinine concentrations, and more proteinuria than White patients. […] In addition, Black patients, Hispanic patients, and those living in poverty have a worse prognosis than White patients and those with a higher socioeconomic status. […] However, the higher frequency of LN in Black populations persists even after correction for socioeconomic factors.

• #18 Lupus Nephritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25699

  Lupus nephritis affects approximately 40% of patients with SLE and is the most prevalent form of secondary glomerulonephritis. […] Around 10% to 30% of patients with lupus nephritis will progress to ESRD within 10 years. […] Lupus nephritis typically develops early in the disease course, most commonly in women between the ages of 20 and 40. […] SLE has a higher prevalence in women, with a female-to-male ratio of 9:1. […] Lupus nephritis is more common in Asian individuals with SLE than in their White counterparts, but the 10-year outcome and survival rates tend to be better in Asians. […] Black and Hispanic patients with SLE generally present with higher creatinine levels and more proteinuria at the time of diagnosis than White patients. […] Results from multiple lupus nephritis studies indicate that class IV is the most common form and is associated with the worst prognosis. […] A meta-analysis revealed that 15% to 30% of patients with class IV disease fail to achieve remission, and of those who do, 15% to 30% experience relapse. […] The mortality rate per 100 patient-years decreased from 11.1 between 1995 and 1999 to 6.7 between 2010 and 2014.

• #19 Insights into the Epidemiology and Management of Lupus Nephritis from the U.S. Rheumatologist’s Perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5679458/

  Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that disproportionately affects non-Whites and those in lower socioeconomic groups. This review discusses recent data on the incidence, prevalence, and outcomes of patients with lupus nephritis with a focus on low-income US Medicaid patients. […] The lack of sustained progress in LN outcomes may be due to poor healthcare access for some groups, limited efficacy of current therapies, and/or their adverse effects. […] SLE and LN both occur disproportionately among non-Whites, which is well demonstrated in the heterogeneous population of the US. […] A socioeconomic gradient is apparent in the prevalence of LN, with increased prevalence in poorer geographic areas that persists after adjustment for age, sex, and ethnicity.

• #20 Lupus Nephritis from Pathogenesis to New Therapies: An Update

  https://www.mdpi.com/1422-0067/25/16/8981

  The overall incidence of LN seems to be higher in women than men, with a male-to-female ratio of approximately 1:5. […] Despite progress, LN prognosis remains rather unpredictable and around 10–30% of patients progress to ESRD within the first ten years of the disease. […] Patients of Hispanic and African descent are characterized by increased disease activity and relapse rates, more rapid progression to chronic kidney disease (CKD) and early mortality, whereas male sex and increased creatinine levels at diagnosis are independent prognostic elements for CKD in Caucasians with LN. […] The incidence of ESRD in wealthy nations experienced a significant decline from the 1970s to the mid-1990s and it has since stabilized, whereas poverty is a significant risk factor for progression of LN, regardless of race or ethnicity.

• #21 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  There is a higher incidence of LN among patients with SLE in the United States as compared with Europe, which may in part reflect racial and ethnic differences. […] The incidence of LN is higher in Black patients with SLE (34 to 51 percent), Hispanic patients (31 to 43 percent), and Asian patients (33 to 55 percent) than it is in White patients (14 to 23 percent). […] Black patients and Hispanic patients also tend to present with more severe underlying histopathology, higher serum creatinine concentrations, and more proteinuria than White patients. […] In addition, Black patients, Hispanic patients, and those living in poverty have a worse prognosis than White patients and those with a higher socioeconomic status. […] However, the higher frequency of LN in Black populations persists even after correction for socioeconomic factors.

• #22

  https://journals.lww.com/co-rheumatology/fulltext/2019/11000/update_on_lupus_epidemiology__advancing_health.20.aspx

  Data indicated that blacks, APIs, and Hispanics are at increased risk of developing severe manifestations following SLE diagnosis. […] Blacks and APIs had a higher prevalence of lupus nephritis (20 and 52%, respectively), compared with 13-14% among the other groups. […] The power of the CDC registries can be extended beyond the initial surveillance periods through matching with other population-based databases and leveraging identification of nearly all validated SLE cases in an area without reliance on administrative data for case ascertainment. […] A consistent finding of epidemiological studies is the higher incidence of lupus nephritis and end-stage renal disease in Blacks and Hispanics with SLE.

• #23 Lupus nephritis, an update | Revista Colombiana de Reumatología (English Edition)

  https://www.elsevier.es/es-revista-revista-colombiana-reumatologia-english-edition–474-articulo-lupus-nephritis-an-update-S2444440523000687

  Lupus Nephritis (LN) is the most common cause of kidney involvement in SLE. Approximately 50% of patients with SLE suffer LN at some point in their disease, being a risk factor for morbidity and mortality. […] About 74% of patients with SLE will develop LN at some point during the course of their disease. The prevalence of LN is variable in different regions: in the United States and Canada is 4.8-78.5% per 100,000 inhabitants; in Europe, from 25 to 91% per 100,000 inhabitants; in Australia, from 19 to 63% per 100,000 inhabitants; in China, from 30 to 50% per 100,000 inhabitants; in Japan, from 8 to 18% per 100,000 inhabitants. In Colombia, 50 to 55% of adults and 75% of children with SLE present LN at some point of their evolution. […] The heterogeneous pathophysiology of LN is a consequence of the interaction between genetic, environmental, and sociodemographic factors that influence clinical manifestations and renal involvement.

• #24 Lupus nephritis, an update | Revista Colombiana de Reumatología (English Edition)

  https://www.elsevier.es/es-revista-revista-colombiana-reumatologia-english-edition–474-articulo-lupus-nephritis-an-update-S2444440523000687

  Lupus Nephritis (LN) is the most common cause of kidney involvement in SLE. Approximately 50% of patients with SLE suffer LN at some point in their disease, being a risk factor for morbidity and mortality. […] About 74% of patients with SLE will develop LN at some point during the course of their disease. The prevalence of LN is variable in different regions: in the United States and Canada is 4.8-78.5% per 100,000 inhabitants; in Europe, from 25 to 91% per 100,000 inhabitants; in Australia, from 19 to 63% per 100,000 inhabitants; in China, from 30 to 50% per 100,000 inhabitants; in Japan, from 8 to 18% per 100,000 inhabitants. In Colombia, 50 to 55% of adults and 75% of children with SLE present LN at some point of their evolution. […] The heterogeneous pathophysiology of LN is a consequence of the interaction between genetic, environmental, and sociodemographic factors that influence clinical manifestations and renal involvement.

• #25 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  There is a higher incidence of LN among patients with SLE in the United States as compared with Europe, which may in part reflect racial and ethnic differences. […] The incidence of LN is higher in Black patients with SLE (34 to 51 percent), Hispanic patients (31 to 43 percent), and Asian patients (33 to 55 percent) than it is in White patients (14 to 23 percent). […] Black patients and Hispanic patients also tend to present with more severe underlying histopathology, higher serum creatinine concentrations, and more proteinuria than White patients. […] In addition, Black patients, Hispanic patients, and those living in poverty have a worse prognosis than White patients and those with a higher socioeconomic status. […] However, the higher frequency of LN in Black populations persists even after correction for socioeconomic factors.

• #26 POS1430 EPIDEMIOLOGY OF LUPUS NEPHRITIS IN BRAZIL: FINDINGS FROM THE MACUNAÍMA STUDY – A NATIONWIDE MULTICENTRIC STUDY | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/80/Suppl_1/999.1

  Lupus nephritis (LN) is one of the most serious organic manifestations of systemic lupus erythematosus (SLE). Ethnicity can contribute to disparities in the prevalence and disease activity of LN. […] To assess the prevalence of LN in Brazilian patients with SLE and to determine factors associated with LN activity across the country. […] Overall, 300 Brazilian patients with SLE were included in the study. […] The prevalence of LN in the paired sample (N=291) was 51.5%, with a disparity between centres (p0.001; Figure 1A). […] Disparities in the prevalence of LN and its activity were evident between the regions across Brazil, highlighting differences in clinical factors, regional factors, and patterns of care.

• #27 Incidence, Prevalence, and Mortality of Lupus Nephritis: A Population-Based Study Over Four Decades—The Lupus Midwest Network (LUMEN)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10065880/

  There is paucity of population-based studies investigating the epidemiology of lupus nephritis (LN) in the US and long-term secular trends of the disease and its outcomes. […] We aimed to examine the epidemiology of LN in a well-defined eight-county region in the US. […] Average annual LN incidence between 1976 and 2018 was 1 per 100,000 population (95%CI 0.8-1.3) and highest in the 30-39 age group. […] Between 19761989 and 20002018 periods, overall incidence of LN increased from 0.7 to 1.3 per 100,000, but this was not statistically significant. […] Estimated LN prevalence increased from 16.8 in 1985 to 21.2 per 100,000 in 2015. […] The incidence and prevalence of LN in this area increased in the last four decades. […] LN patients have poor outcomes with high rates of ESRD and mortality rates six times that of the general population.

• #28 512 The rising incidence, prevalence and mortality gap of lupus nephritis: a population-based study over four decades | Lupus Science & Medicine

  https://lupus.bmj.com/content/8/Suppl_2/A19.1

  There is paucity of population-based studies that investigate the epidemiology of lupus nephritis (LN) and its long-term outcomes. […] The overall LN incidence between 1976 and 2018 was estimated at 1 per 100,000 (95%CI 0.8-1.3). The overall incidence of LN increased from 0.7 to 1.3 with sex specific incidence in males quadrupling from 0.2 to 0.8 per 100,000 between 1976-1988 and 2000-2018 periods. […] LN prevalence increased from 16.8 per 100,000 in 1985 to 21.2 in 2015. […] The incidence and prevalence of LN has increased in the last 40 years. Long-term outcomes in patients with LN remain poor. Patients with LN had a mortality rate of more than 50% at 20 years and of those surviving, 40% had ESRD. The widening mortality gap we observed with near doubling of SMR each decade shows that the mortality reduction in LN patients is not keeping up with the mortality improvements of the general population despite changes in clinical practice over the decades.

• #29 Evolution in epidemiology of lupus nephritis

  http://www.njcndt.com/EN/10.3969/j.issn.1006-298X.2017.06.014

  Lupus nephritis(LN)is one of the most common and severe complication of systemic lupus erythematosus(SLE). Up to 20 percent of LN patients will progress to end stage renal disease(ESRD)within 10 years after their diagnosis, which brings substantial health burden to the patients. […] One research from America found that the rates of endstage LN stopped increasing between 1995 and 2010 and declined in the last decade. Research from China observed that renal outcome improved from 1994 to 2010. This review discusses recent data on the changes in epidemiology of patients with LN, especially on the trends in outcomes.

• #30 Contemporary Incidence of Lupus Nephritis Among Patients with Systemic Lupus Erythematosus in the United States – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/contemporary-incidence-of-lupus-nephritis-among-patients-with-systemic-lupus-erythematosus-in-the-united-states/

  Contemporary Incidence of Lupus Nephritis Among Patients with Systemic Lupus Erythematosus in the United States […] Lupus nephritis is a leading cause of morbidity in patients with systemic lupus erythematosus (SLE). […] We sought to determine the incidence of lupus nephritis (LN) in a contemporary United States SLE cohort. […] A total of 6,025 patients developed lupus nephritis during a mean of 50.2 months (SD 40.3) follow up, and 4,175 (69.3%) met the stricter secondary definition. […] The overall cumulative incidence of LN was 24.9% at 5 years, 30.1% at 10 years, and 34.4% at 15 years of follow up. […] The incidence of LN was higher among men with SLE (44.7% vs 28.6% of women at 10 years). […] In this contemporary, multi-center, EHR-based SLE inception cohort, one third of patients with SLE developed LN after 15 years of follow-up, and just over half of all cases were identified as an early manifestation around the time of SLE diagnosis. […] The incidence of LN was higher in non-white individuals and in men with SLE. […] Despite improved treatment for SLE in recent years, LN remains a frequent manifestation among patients with SLE that benefits from early identification and treatment.

• #31 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  Most patients with systemic lupus erythematosus (SLE) will have clinical evidence of kidney disease, usually an abnormal urinalysis, at some point in the course of their disease. […] Lupus nephritis (LN) typically develops early in the disease course. […] Clinically evident kidney disease eventually occurs in up to one-half of patients with SLE, and up to 10 percent of patients with LN will develop end-stage kidney disease (ESKD). […] In one cohort of 1827 patients with newly diagnosed SLE, LN occurred in 700 (38 percent) patients followed for a mean of 4.6 years. […] The overall 10-year incidence of ESKD was 4 percent and, in patients with LN, 10 percent. […] In this cohort, LN was also associated with a threefold increased risk of death. […] Study-to-study variations in prevalence estimates of LN may be due in part to racial differences in disease prevalence and/or risk of nephropathy, as well as varying definitions and/or disease ascertainment.

• #32 Epidemiology, pathophysiology and management of Lupus Nephritis – Conquest Health

  https://conquest.health/epidemiology-pathophysiology-and-management-of-lupus-nephritis/

  Lupus nephritis (LN) is present in approximately 25% of patients at the time of diagnosis and eventually develops in up to 60% of adults and 80% of children. […] Lupus nephritis (LN) occurs in ~50% of patients with SLE. LN typically develops early in the disease course, generally within the first 6 to 36 months, and maybe present at initial diagnosis. The incidence of LN is higher in Asians (55%), followed by Africans (51%), and Hispanics(43%) when compared with Caucasians (14%). […] For SLE patients, LN continues to be a major cause of morbidity and mortality. The majority of patients get LN during their prime years of life, which harms their livelihoods and families, as well as society as a whole.

• #33 Lupus Nephritis in Children: Novel Perspectives

  https://www.mdpi.com/1648-9144/59/10/1841

  cSLE is a rare disorder, with a reported prevalence of 1.9–25.7 per 100,000 children and an incidence of 0.3–0.9 per 100,000 per year worldwide, accounting for 10–20% of SLE cases. […] Among patients with cSLE, the rate of those developing LN varies among different registries from 32 to 55%. […] LN usually develops early in the disease course, with data from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry revealing its occurrence in 88% of cases in the first year after cSLE diagnosis and in 93% within two calendar years.

• #34 Comparison of lupus patients with early and late onset nephritis: a study in 71 patients from a single referral center | Advances in Rheumatology | Full Text

  https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-019-0105-5

  Nephritis occurs frequently in systemic lupus erythematosus (SLE) and may worsen disease morbidity and mortality. Knowing all characteristics of this manifestation helps to a prompt recognition and treatment. […] Epidemiological, serological, clinical and treatment data were collected from charts and compared. […] In this sample, 70.4% had early onset nephritis and 29.6% had late onset. […] Most of SLE patients had nephritis in the first 5 years of disease. No major differences were noted when disease profile or treatment outcome of early and late onset nephritis were compared. […] Renal involvement in systemic lupus erythematosus (SLE) is one of most common and feared manifestations of this disease as it is related to high morbidity and increased rate of mortality. […] It has been estimated that almost half of adults and 80-90% of children with systemic lupus will develop kidney involvement and that 10% of them will go into renal failure.

• #35 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  The time course for the development of LN varies with sex, age, and ethnicity. […] A number of patient characteristics place patients with LN at greater risk for progressive kidney disease including African or Hispanic ancestry, male sex, pediatric onset, frequent relapses or incomplete remission, and proteinuria >4 g/day at diagnosis.

• #36 Lupus Nephritis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/330369-overview

  Most patients with SLE develop lupus nephritis early in their disease course. SLE is more common among women in the third decade of life, and lupus nephritis typically occurs in patients aged 20-40 years. […] Because the overall prevalence of SLE is higher in females (ie, female-to-male ratio of 9:1), lupus nephritis is also more common in females; however, clinical renal disease has a worse prognosis and is more common in males with SLE. […] SLE is more common in African Americans and Asians than in white people, with the highest prevalence in Caribbean people. The prevalence of lupus nephritis is much higher in Asians than in Whites with SLE, but the 10-year renal outcome and renal survival rate appear to be better in Asians. […] Particularly severe lupus nephritis may be more common in African Americans and Asians than in other ethnic groups.

• #37 A Systematic Review and Meta-analysis of Prevalence of Biopsy-Proven Lupus Nephritis | Volume 33 – Issue 1 – March 2018 | Archives of Rheumatology

  https://www.archivesofrheumatology.org/full-text/929

  The pooled rate of BPLN among patients with SGD was 60% (95% CI: 45-74%, I(2)= 99.3%, p). […] The sex distribution in patients with BPLN was reported by 11 studies, with the percentage of females ranging from 51.4% to 92.5%. […] The pooled prevalence of BPLN in female based on a random-effects model was 85% (95% CI: 0.79 to 91%; I(2)= 81.37, p). […] Class IV nephritis was the most common BPLN class in each of the five studies, and the proportion of patients with class IV disease did not differ significantly between different regions, based on comparisons of 95% CIs. […] The overall 5-, 10-, and 20-year survival rates were 94% (95% CI: 88-99%, I(2)= 86.2%, p), 86% (95% CI: 78-91%, I(2)= 84.8%, p), and 71% (95% CI: 62-78%, I(2)= 78.2%, p), respectively. […] Class IV glomerulonephritis was found to be the most frequent risk factor.

• #38 Lupus Nephritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25699

  Lupus nephritis affects approximately 40% of patients with SLE and is the most prevalent form of secondary glomerulonephritis. […] Around 10% to 30% of patients with lupus nephritis will progress to ESRD within 10 years. […] Lupus nephritis typically develops early in the disease course, most commonly in women between the ages of 20 and 40. […] SLE has a higher prevalence in women, with a female-to-male ratio of 9:1. […] Lupus nephritis is more common in Asian individuals with SLE than in their White counterparts, but the 10-year outcome and survival rates tend to be better in Asians. […] Black and Hispanic patients with SLE generally present with higher creatinine levels and more proteinuria at the time of diagnosis than White patients. […] Results from multiple lupus nephritis studies indicate that class IV is the most common form and is associated with the worst prognosis. […] A meta-analysis revealed that 15% to 30% of patients with class IV disease fail to achieve remission, and of those who do, 15% to 30% experience relapse. […] The mortality rate per 100 patient-years decreased from 11.1 between 1995 and 1999 to 6.7 between 2010 and 2014.

• #39 Insights into the Epidemiology and Management of Lupus Nephritis from the U.S. Rheumatologist’s Perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5679458/

  These studies suggest high barriers to healthcare exist in resource-poor areas of the US, but barriers are probably higher in developing countries, which may contribute to increased rates of SLE-associated ESRD outside the US. […] The standardized incidence rate of LN-related ESRD in the US is higher among all non-Whites, and 7-fold greater among Blacks compared to Whites. […] The risk of developing LN-related ESRD at five, ten, and fifteen years is 11, 17, and 22% (CI 1012%, 1618%, 2023%) (4), and patients with class IV LN are especially vulnerable: 44% develop ESRD at 15 years (4). […] The ACR and EULAR/ERA-EDTA recommend close monitoring for new onset or recurrent LN in SLE patients by routinely screening for kidney involvement at least every three to six months, and obtaining a kidney biopsy for persistent evidence of LN barring any contraindication. […] Less than 60% of class III to V LN patients achieve a complete response with current induction regimens (27), and the risk of LN-related ESRD at five, ten, and fifteen years remains at 11, 17, and 22% (CI 1012%, 1618%, 2023%) for the last decade (4).

• #40 Managing Lupus Nephritis: From Clinical and Economic Implications to Diagnosis and Treatment Advances

  https://www.ajmc.com/view/managing-lupus-nephritis-from-clinical-and-economic-implications-to-diagnosis-and-treatment-advances

  Early identification of renal involvement is critical for identifying kidney damage, allowing prompt diagnosis and treatment of LN and promoting the best possible outcomes in patients with SLE. Recommendations include monitoring patients with no previous history of or stable LN every 3 to 6 months; those at high risk of developing LN (eg, males, individuals with juvenile lupus onset, or patients who test positive for C1q and certain C-reactive proteins) should be tested at least every 3 months. Surveillance should include regular urinalysis and sediment analysis; testing for antiphospholipid, anti-double stranded DNA, and anti-C1q autoantibodies; and tracking of C3 and C4 complement levels, blood pressure, and body weight. […] In patients with LN, periods of active disease and ESRD are associated with higher health care costs than are periods of low disease activity, regardless of insurance coverage. Further results of the previously mentioned analysis of 2007-2019 Optum pharmacy and medical claims data showed that lower disease activity was associated with lower LN treatment use.

• #41 Managing Lupus Nephritis: From Clinical and Economic Implications to Diagnosis and Treatment Advances

  https://www.ajmc.com/view/managing-lupus-nephritis-from-clinical-and-economic-implications-to-diagnosis-and-treatment-advances

  Early identification of renal involvement is critical for identifying kidney damage, allowing prompt diagnosis and treatment of LN and promoting the best possible outcomes in patients with SLE. Recommendations include monitoring patients with no previous history of or stable LN every 3 to 6 months; those at high risk of developing LN (eg, males, individuals with juvenile lupus onset, or patients who test positive for C1q and certain C-reactive proteins) should be tested at least every 3 months. Surveillance should include regular urinalysis and sediment analysis; testing for antiphospholipid, anti-double stranded DNA, and anti-C1q autoantibodies; and tracking of C3 and C4 complement levels, blood pressure, and body weight. […] In patients with LN, periods of active disease and ESRD are associated with higher health care costs than are periods of low disease activity, regardless of insurance coverage. Further results of the previously mentioned analysis of 2007-2019 Optum pharmacy and medical claims data showed that lower disease activity was associated with lower LN treatment use.

• #42

  https://journals.lww.com/cjasn/fulltext/2017/05000/update_on_lupus_nephritis.16.aspx

  SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. […] The prevalence of SLE and the chances of developing lupus nephritis (LN) vary considerably between different regions of the world and different races and ethnicities. […] In the United States, the higher frequency of LN in black populations persists after adjustment for socioeconomic factors. […] Additionally, black and Hispanic SLE patients develop LN earlier, and have worse outcomes than white patients with SLE, including death and ESRD. […] The more aggressive disease course in black individuals might be the result of a higher incidence of diffuse proliferative LN, or the presence of more high-risk features within the same LN histologic class when compared with white individuals. […] LN is a major risk factor for morbidity and mortality in SLE and 10% of patients with LN will develop ESRD. […] The risk of ESRD is higher in certain subsets of LN. […] Patients with LN also have a higher standardized mortality ratio and die earlier than SLE patients without LN. […] Importantly, 10-year survival improves from 46% to 95% if disease remission can be achieved.

• #43 Insights into the Epidemiology and Management of Lupus Nephritis from the U.S. Rheumatologist’s Perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5679458/

  These studies suggest high barriers to healthcare exist in resource-poor areas of the US, but barriers are probably higher in developing countries, which may contribute to increased rates of SLE-associated ESRD outside the US. […] The standardized incidence rate of LN-related ESRD in the US is higher among all non-Whites, and 7-fold greater among Blacks compared to Whites. […] The risk of developing LN-related ESRD at five, ten, and fifteen years is 11, 17, and 22% (CI 1012%, 1618%, 2023%) (4), and patients with class IV LN are especially vulnerable: 44% develop ESRD at 15 years (4). […] The ACR and EULAR/ERA-EDTA recommend close monitoring for new onset or recurrent LN in SLE patients by routinely screening for kidney involvement at least every three to six months, and obtaining a kidney biopsy for persistent evidence of LN barring any contraindication. […] Less than 60% of class III to V LN patients achieve a complete response with current induction regimens (27), and the risk of LN-related ESRD at five, ten, and fifteen years remains at 11, 17, and 22% (CI 1012%, 1618%, 2023%) for the last decade (4).

• #44 Insights into the Epidemiology and Management of Lupus Nephritis from the U.S. Rheumatologist’s Perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5679458/

  These studies suggest high barriers to healthcare exist in resource-poor areas of the US, but barriers are probably higher in developing countries, which may contribute to increased rates of SLE-associated ESRD outside the US. […] The standardized incidence rate of LN-related ESRD in the US is higher among all non-Whites, and 7-fold greater among Blacks compared to Whites. […] The risk of developing LN-related ESRD at five, ten, and fifteen years is 11, 17, and 22% (CI 1012%, 1618%, 2023%) (4), and patients with class IV LN are especially vulnerable: 44% develop ESRD at 15 years (4). […] The ACR and EULAR/ERA-EDTA recommend close monitoring for new onset or recurrent LN in SLE patients by routinely screening for kidney involvement at least every three to six months, and obtaining a kidney biopsy for persistent evidence of LN barring any contraindication. […] Less than 60% of class III to V LN patients achieve a complete response with current induction regimens (27), and the risk of LN-related ESRD at five, ten, and fifteen years remains at 11, 17, and 22% (CI 1012%, 1618%, 2023%) for the last decade (4).

• #45 Lupus Nephritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25699

  Lupus nephritis affects approximately 40% of patients with SLE and is the most prevalent form of secondary glomerulonephritis. […] Around 10% to 30% of patients with lupus nephritis will progress to ESRD within 10 years. […] Lupus nephritis typically develops early in the disease course, most commonly in women between the ages of 20 and 40. […] SLE has a higher prevalence in women, with a female-to-male ratio of 9:1. […] Lupus nephritis is more common in Asian individuals with SLE than in their White counterparts, but the 10-year outcome and survival rates tend to be better in Asians. […] Black and Hispanic patients with SLE generally present with higher creatinine levels and more proteinuria at the time of diagnosis than White patients. […] Results from multiple lupus nephritis studies indicate that class IV is the most common form and is associated with the worst prognosis. […] A meta-analysis revealed that 15% to 30% of patients with class IV disease fail to achieve remission, and of those who do, 15% to 30% experience relapse. […] The mortality rate per 100 patient-years decreased from 11.1 between 1995 and 1999 to 6.7 between 2010 and 2014.

• #46 Lupus Nephritis from Pathogenesis to New Therapies: An Update

  https://www.mdpi.com/1422-0067/25/16/8981

  The overall incidence of LN seems to be higher in women than men, with a male-to-female ratio of approximately 1:5. […] Despite progress, LN prognosis remains rather unpredictable and around 10–30% of patients progress to ESRD within the first ten years of the disease. […] Patients of Hispanic and African descent are characterized by increased disease activity and relapse rates, more rapid progression to chronic kidney disease (CKD) and early mortality, whereas male sex and increased creatinine levels at diagnosis are independent prognostic elements for CKD in Caucasians with LN. […] The incidence of ESRD in wealthy nations experienced a significant decline from the 1970s to the mid-1990s and it has since stabilized, whereas poverty is a significant risk factor for progression of LN, regardless of race or ethnicity.

• #47 Insights into the Epidemiology and Management of Lupus Nephritis from the U.S. Rheumatologist’s Perspective

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5679458/

  These studies suggest high barriers to healthcare exist in resource-poor areas of the US, but barriers are probably higher in developing countries, which may contribute to increased rates of SLE-associated ESRD outside the US. […] The standardized incidence rate of LN-related ESRD in the US is higher among all non-Whites, and 7-fold greater among Blacks compared to Whites. […] The risk of developing LN-related ESRD at five, ten, and fifteen years is 11, 17, and 22% (CI 1012%, 1618%, 2023%) (4), and patients with class IV LN are especially vulnerable: 44% develop ESRD at 15 years (4). […] The ACR and EULAR/ERA-EDTA recommend close monitoring for new onset or recurrent LN in SLE patients by routinely screening for kidney involvement at least every three to six months, and obtaining a kidney biopsy for persistent evidence of LN barring any contraindication. […] Less than 60% of class III to V LN patients achieve a complete response with current induction regimens (27), and the risk of LN-related ESRD at five, ten, and fifteen years remains at 11, 17, and 22% (CI 1012%, 1618%, 2023%) for the last decade (4).

• #48 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  The time course for the development of LN varies with sex, age, and ethnicity. […] A number of patient characteristics place patients with LN at greater risk for progressive kidney disease including African or Hispanic ancestry, male sex, pediatric onset, frequent relapses or incomplete remission, and proteinuria >4 g/day at diagnosis.

• #49 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  The time course for the development of LN varies with sex, age, and ethnicity. […] A number of patient characteristics place patients with LN at greater risk for progressive kidney disease including African or Hispanic ancestry, male sex, pediatric onset, frequent relapses or incomplete remission, and proteinuria >4 g/day at diagnosis.

• #50 Lupus nephritis, an update | Revista Colombiana de Reumatología (English Edition)

  https://www.elsevier.es/es-revista-revista-colombiana-reumatologia-english-edition–474-articulo-lupus-nephritis-an-update-S2444440523000687

  In relation to sociodemographic data, men with SLE tend to have a more aggressive disease, with greater renal and cardiovascular involvement, as well as a higher probability of developing end-stage chronic renal failure (ESRD) than women. […] There is an enormous racial expression that conditions the appearance or evolution of LN. In a North American multicenter study, the incidence of LN and progression to ESRD is higher in African Americans (51%), followed by Hispanics (43%) and Asians (35%), compared with Caucasian patients (14-23%). […] Mortality from LN occurs in 5%-25% of patients with proliferative LN within 5 years after onset.

• #51

  https://journals.lww.com/cjasn/fulltext/2017/05000/update_on_lupus_nephritis.16.aspx

  SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. […] The prevalence of SLE and the chances of developing lupus nephritis (LN) vary considerably between different regions of the world and different races and ethnicities. […] In the United States, the higher frequency of LN in black populations persists after adjustment for socioeconomic factors. […] Additionally, black and Hispanic SLE patients develop LN earlier, and have worse outcomes than white patients with SLE, including death and ESRD. […] The more aggressive disease course in black individuals might be the result of a higher incidence of diffuse proliferative LN, or the presence of more high-risk features within the same LN histologic class when compared with white individuals. […] LN is a major risk factor for morbidity and mortality in SLE and 10% of patients with LN will develop ESRD. […] The risk of ESRD is higher in certain subsets of LN. […] Patients with LN also have a higher standardized mortality ratio and die earlier than SLE patients without LN. […] Importantly, 10-year survival improves from 46% to 95% if disease remission can be achieved.

• #52 A Systematic Review and Meta-analysis of Prevalence of Biopsy-Proven Lupus Nephritis | Volume 33 – Issue 1 – March 2018 | Archives of Rheumatology

  https://www.archivesofrheumatology.org/full-text/929

  The pooled rate of BPLN among patients with SGD was 60% (95% CI: 45-74%, I(2)= 99.3%, p). […] The sex distribution in patients with BPLN was reported by 11 studies, with the percentage of females ranging from 51.4% to 92.5%. […] The pooled prevalence of BPLN in female based on a random-effects model was 85% (95% CI: 0.79 to 91%; I(2)= 81.37, p). […] Class IV nephritis was the most common BPLN class in each of the five studies, and the proportion of patients with class IV disease did not differ significantly between different regions, based on comparisons of 95% CIs. […] The overall 5-, 10-, and 20-year survival rates were 94% (95% CI: 88-99%, I(2)= 86.2%, p), 86% (95% CI: 78-91%, I(2)= 84.8%, p), and 71% (95% CI: 62-78%, I(2)= 78.2%, p), respectively. […] Class IV glomerulonephritis was found to be the most frequent risk factor.

• #53

  https://journals.lww.com/cjasn/fulltext/2017/05000/update_on_lupus_nephritis.16.aspx

  SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. […] The prevalence of SLE and the chances of developing lupus nephritis (LN) vary considerably between different regions of the world and different races and ethnicities. […] In the United States, the higher frequency of LN in black populations persists after adjustment for socioeconomic factors. […] Additionally, black and Hispanic SLE patients develop LN earlier, and have worse outcomes than white patients with SLE, including death and ESRD. […] The more aggressive disease course in black individuals might be the result of a higher incidence of diffuse proliferative LN, or the presence of more high-risk features within the same LN histologic class when compared with white individuals. […] LN is a major risk factor for morbidity and mortality in SLE and 10% of patients with LN will develop ESRD. […] The risk of ESRD is higher in certain subsets of LN. […] Patients with LN also have a higher standardized mortality ratio and die earlier than SLE patients without LN. […] Importantly, 10-year survival improves from 46% to 95% if disease remission can be achieved.

• #54 Lupus nephritis, an update | Revista Colombiana de Reumatología (English Edition)

  https://www.elsevier.es/es-revista-revista-colombiana-reumatologia-english-edition–474-articulo-lupus-nephritis-an-update-S2444440523000687

  In relation to sociodemographic data, men with SLE tend to have a more aggressive disease, with greater renal and cardiovascular involvement, as well as a higher probability of developing end-stage chronic renal failure (ESRD) than women. […] There is an enormous racial expression that conditions the appearance or evolution of LN. In a North American multicenter study, the incidence of LN and progression to ESRD is higher in African Americans (51%), followed by Hispanics (43%) and Asians (35%), compared with Caucasian patients (14-23%). […] Mortality from LN occurs in 5%-25% of patients with proliferative LN within 5 years after onset.

• #55 512 The rising incidence, prevalence and mortality gap of lupus nephritis: a population-based study over four decades | Lupus Science & Medicine

  https://lupus.bmj.com/content/8/Suppl_2/A19.1

  There is paucity of population-based studies that investigate the epidemiology of lupus nephritis (LN) and its long-term outcomes. […] The overall LN incidence between 1976 and 2018 was estimated at 1 per 100,000 (95%CI 0.8-1.3). The overall incidence of LN increased from 0.7 to 1.3 with sex specific incidence in males quadrupling from 0.2 to 0.8 per 100,000 between 1976-1988 and 2000-2018 periods. […] LN prevalence increased from 16.8 per 100,000 in 1985 to 21.2 in 2015. […] The incidence and prevalence of LN has increased in the last 40 years. Long-term outcomes in patients with LN remain poor. Patients with LN had a mortality rate of more than 50% at 20 years and of those surviving, 40% had ESRD. The widening mortality gap we observed with near doubling of SMR each decade shows that the mortality reduction in LN patients is not keeping up with the mortality improvements of the general population despite changes in clinical practice over the decades.

• #56 Lupus Nephritis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25699

  Lupus nephritis affects approximately 40% of patients with SLE and is the most prevalent form of secondary glomerulonephritis. […] Around 10% to 30% of patients with lupus nephritis will progress to ESRD within 10 years. […] Lupus nephritis typically develops early in the disease course, most commonly in women between the ages of 20 and 40. […] SLE has a higher prevalence in women, with a female-to-male ratio of 9:1. […] Lupus nephritis is more common in Asian individuals with SLE than in their White counterparts, but the 10-year outcome and survival rates tend to be better in Asians. […] Black and Hispanic patients with SLE generally present with higher creatinine levels and more proteinuria at the time of diagnosis than White patients. […] Results from multiple lupus nephritis studies indicate that class IV is the most common form and is associated with the worst prognosis. […] A meta-analysis revealed that 15% to 30% of patients with class IV disease fail to achieve remission, and of those who do, 15% to 30% experience relapse. […] The mortality rate per 100 patient-years decreased from 11.1 between 1995 and 1999 to 6.7 between 2010 and 2014.

• #57 Lupus nephritis: Diagnosis and classification – UpToDate

  https://www.uptodate.com/contents/lupus-nephritis-diagnosis-and-classification/print

  Most patients with systemic lupus erythematosus (SLE) will have clinical evidence of kidney disease, usually an abnormal urinalysis, at some point in the course of their disease. […] Lupus nephritis (LN) typically develops early in the disease course. […] Clinically evident kidney disease eventually occurs in up to one-half of patients with SLE, and up to 10 percent of patients with LN will develop end-stage kidney disease (ESKD). […] In one cohort of 1827 patients with newly diagnosed SLE, LN occurred in 700 (38 percent) patients followed for a mean of 4.6 years. […] The overall 10-year incidence of ESKD was 4 percent and, in patients with LN, 10 percent. […] In this cohort, LN was also associated with a threefold increased risk of death. […] Study-to-study variations in prevalence estimates of LN may be due in part to racial differences in disease prevalence and/or risk of nephropathy, as well as varying definitions and/or disease ascertainment.

• #58 Lupus Nephritis from Pathogenesis to New Therapies: An Update

  https://www.mdpi.com/1422-0067/25/16/8981

  Lupus Nephritis (LN) represents one of the most severe and frequent complications of Systemic Lupus Erythematosus (SLE) and a major risk factor for morbidity and mortality, potentially leading to end-stage renal disease (ESRD). […] The worldwide incidence of SLE is estimated to be 5.14 per 100,000 person-years and the prevalence would be 43.7 per 100,000 individuals, affecting a total of 3.41 million people. However, epidemiological data on SLE are missing in 79.8% of nations. […] Overall more than 10% of kidney biopsies lead to a diagnosis of LN, which affects around 40% of SLE patients, representing the most frequent secondary glomerular disease. […] The prevalence of SLE and the chances of developing LN vary considerably between different regions of the world, socioeconomic status, and ethnicities.

• #59

  https://journals.lww.com/co-rheumatology/fulltext/2019/11000/update_on_lupus_epidemiology__advancing_health.20.aspx

  The Centers for Disease Control and Prevention National Lupus Registries underscored higher susceptibility of both systemic lupus erythematosus (SLE) and primary cutaneous lupus among people of color, compared with whites. […] Not only does SLE disproportionately strike people from racial and ethnic minorities, those individuals are also at increased risk of developing severe manifestations following SLE diagnosis. […] Mortality is higher and death occurs at a younger age among blacks, compared with whites. […] The CDC National Lupus Registries were created from an unprecedented national lupus surveillance project aimed at addressing the limitations of previous epidemiologic data, particularly in racial/ethnic minority populations in the United States. […] Racial and ethnic differences were recently analyzed in lupus manifestations and in the timing and risk of developing severe manifestations in the California Lupus Surveillance Project (CLSP).

• #60 Epidemiology of Systemic Lupus Erythematosus (SLE) and Lupus Nephritis (LN) in England: a retrospective observational study using CPRD-HES linked data | CPRD

  https://www.cprd.com/approved-studies/epidemiology-systemic-lupus-erythematosus-sle-and-lupus-nephritis-ln-england

  Systemic lupus erythematosus (SLE) is a condition in which the body cannot differentiate between healthy tissue and foreign bodies or infections. […] This type of kidney disease is called Lupus Nephritis (LN) and can cause the kidneys stop working properly. […] Recent data suggest prevalence of SLE in the UK is 97 per 100 000, with 86% of observed cases being female. […] It is thought that the prevalence of LN in SLE patients is between 20-60%; however, a previous estimate in CPRD data using two Read codes specific for LN found only 3% of SLE patients recorded as having LN. […] Increasing the sensitivity of algorithms to ascertain patients with LN in CPRD data will help to better understand the epidemiology of SLE and LN in England and aid future research involving this patient group.

• #61

  https://esmed.org/MRA/mra/article/view/6217

  Lupus nephritis is one of the most common severe organ manifestations of systemic lupus erythematosus (SLE). […] The clinical manifestations of lupus nephritis are variable and screening all SLE patients for lupus nephritis is imperative. […] There has been substantial advancement in availability of biomarkers and therapeutic options. This review focuses on epidemiology, early screening, advances in the biomarkers and management of lupus nephritis. […] Inter-ethnic variation in the prevalence and severity of lupus nephritis as well as tolerance and clinical response to various therapeutic regimens for LN has led to variation in screening and treatment of lupus nephritis in SLE patients. Periodic screening of lupus nephritis in patients with SLE is imperative for early detection. […] New serum and urinary biomarkers for LN can help screen and stratify the patients at risk and those having flare-up of LN. […] The development of biomarkers for early detection and novel therapeutics to improve the efficacy-to-toxicity balance for LN are current unmet needs. […] Promising advances have been made in screening and treatment of lupus nephritis.

• #62 Managing Lupus Nephritis: From Clinical and Economic Implications to Diagnosis and Treatment Advances

  https://www.ajmc.com/view/managing-lupus-nephritis-from-clinical-and-economic-implications-to-diagnosis-and-treatment-advances

  Together, these results highlight both the clinical and economic incentives to prevent progression of renal disease in those with SLE. Early diagnosis of LN allows for swift initiation of effective treatment to promote achievement and maintenance of low disease activity, preservation of kidney function, and ultimately, reduction of medication use and overall health care costs.

• #63 Healthcare Resource Utilization and Costs of Management of Lupus Nephritis in Adult and Juvenile Patients with Systemic Lupus Erythematosus – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/healthcare-resource-utilization-and-costs-of-management-of-lupus-nephritis-in-adult-and-juvenile-patients-with-systemic-lupus-erythematosus/

  Healthcare Resource Utilization and Costs of Management of Lupus Nephritis in Adult and Juvenile Patients with Systemic Lupus Erythematosus […] Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus (SLE), which develops in about one-third of SLE patients within 10 years of initial diagnosis. […] The objective of our study was to review and summarize the evidence on costs and healthcare resource utilization (HCU) in patients with LN. […] Of 4,216 records identified in the medical databases, 14 studies reported on costs and HCU in patients with LN. […] In the US, adult SLE patients with LN had significantly higher utilization of outpatient visit-related services and had more hospitalization-based events per year with approximately 6-day longer lengths of stay, compared to matched patients without SLE.

• #64 Healthcare Resource Utilization and Costs of Management of Lupus Nephritis in Adult and Juvenile Patients with Systemic Lupus Erythematosus – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/healthcare-resource-utilization-and-costs-of-management-of-lupus-nephritis-in-adult-and-juvenile-patients-with-systemic-lupus-erythematosus/

  Mean healthcare costs of LN management ranged from $33,500 to $51,000 per year, being 5-7-times higher compared with matched non-SLE controls. […] Development of LN in SLE patients is associated with higher incremental cost of care compared with SLE patients with other manifestations, and patients without SLE in the US and Europe. […] The direct healthcare costs are especially increased in patients with active disease and those with ESKD, suggesting there is a high unmet need for effective therapies to treat LN, prevent its complications, and reduce economic burden on the healthcare systems.

• #65

  https://link.springer.com/article/10.1007/s40744-023-00623-4

  Lupus nephritis (LN), a common manifestation of systemic lupus erythematosus (SLE), is associated with substantial healthcare resource utilization (HCRU) and has an estimated prevalence of 15 per 100,000 in Germany. […] The current complex treatment pathways for LN, and disease burden experienced by patients, require further understanding to improve outcomes with targeted new therapies; this real-world study characterized treatment patterns, HCRU, and costs in patients with active LN initiating immunosuppressant therapy using administrative claims data. […] Most German patients with LN initiating immunosuppressants had 1 treatment discontinuation over the 4-year follow-up period, with a smaller proportion switching therapies; in addition, these patients received high doses of corticosteroids even after initiation of immunosuppressants.

• #66

  https://link.springer.com/article/10.1007/s40744-023-00623-4

  There was considerable HCRU and economic burden seen in patients with LN compared with the non-SLE/LN control group: a higher proportion of patients with LN had hospitalizations, ambulant hospital visits, outpatient visits, outpatient prescriptions, and remedies and other benefits; costs were also higher across all years of follow-up, particularly in year 1 where costs were nearly four times higher in patients with LN compared with the control group. […] Current treatment pathways for LN in Germany may not provide adequate disease management, necessitating more effective, well-tolerated treatments.

• #67 Managing Lupus Nephritis: From Clinical and Economic Implications to Diagnosis and Treatment Advances

  https://www.ajmc.com/view/managing-lupus-nephritis-from-clinical-and-economic-implications-to-diagnosis-and-treatment-advances

  Together, these results highlight both the clinical and economic incentives to prevent progression of renal disease in those with SLE. Early diagnosis of LN allows for swift initiation of effective treatment to promote achievement and maintenance of low disease activity, preservation of kidney function, and ultimately, reduction of medication use and overall health care costs.

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