Lupus Nephritis in Indigenous Australians – A single centre Study

OBJECTIVE: The incidence, presentation and outcomes of lupus nephritis (LN) varies with geography, ethnicity, socioeconomic status, and gender. There is relatively few data on LN in the non-Caucasian populations in Australia. This study describes the clinical presentation, histological features, natural history, and outcomes of a historical cohort of Aboriginal and Torres Strait Islanders people in Far North Queensland with biopsy-proven LN. DESIGN: Retrospective observational study. SETTING: Cairns and Hinterland Hospital and Health Service, Queensland, Australia. PARTICIPANTS: Aboriginal and Torres Strait Islander patients with biopsy-proven LN treated between 1990 and 2013. MAIN OUTCOME MEASURES: Renal replacement therapy and overall patient survival. RESULTS: Aboriginal and Torres Strait Islander people represented a substantial proportion (n=16/40, 40%) of all patients diagnosed with LN during the observation period. The frequency of nephrotic range proteinuria (n=11/14, 78.5%), eGFR <60 mL/min/1.73m2 (n=6/14, 42.8%) and proliferative LN (n=13/16, 81.25%) was high at the time of presentation. Despite use of multiple immunosuppressive agents, the overall rate of remission was poor (n=4/14, 28.5%), and incidence of ESKD (n=4/14, 28.5%) and death (n=5/16, 31.25%) was high. CONCLUSION: The clinical presentation of LN in Aboriginal and Torres Strait Islanders in Far North Queensland is severe and the response to standard immunosuppressive therapy is unsatisfactory. Larger prospective multi-centre studies are required to better understand ethnic disparities in prognosis and response to immunosuppressive therapy in this specific population. This article is protected by copyright. All rights reserved.