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Prevalence of Lupus Nephritis in Patients of Systemic Lupus Erythematosus

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Annals of Medicine and Medical Sciences Volume 05 (2026), Version 03 March 23, 2026 pp. 332 - 335
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Abstract

Background: Systemic Lupus Erythematosus (SLE) is a multifaceted autoimmune disease marked by chronic immune complex formation, leading to diverse clinical manifestations and multi-organ involvement. The objective of the study was to determine the prevalence of Lupus Nephritis in patients of Systemic Lupus Erythematosus. Materials and Methods: A cross sectional study was conducted among 104 patients with Systemic Lupus Erythematosus attending the Rheumatology outpatient department (OPD) and Medicine wards of Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur. The study was done over a period of 2 (two) year from September 2019 to August 2021. Results: The mean age of the study population was 37.95 ± 13.78 years. The duration of Systemic Lupus Erythematosus in 58.7% patients was 3–5 years. The most common age group of occurrence of Lupus Nephritis was 31 – 40 years at 36.7%. Female gender predominance at 96.7% was noted among those with Lupus Nephritis. The prevalence of Lupus Nephritis in Systemic Lupus Erythematosus as per the American College of Rheumatology (ACR) criteria was 28.8%. Conclusion: Lupus Nephritis presents across a broad clinical spectrum ranging from mild proteinuria to rapidly progressive renal failure. The healthcare providers should effectively foster strategies to mitigate the risk of Lupus Nephritis in Systemic Lupus Erythematosus patients so as to potentially improve outcomes for those at risk.

Keywords

Systemic Lupus Erythematosus Proteinuria Gender Lupus Nephritis Renal failure.

Introduction

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder characterized by autoantibody production, immune complex deposition and complement activation, resulting in inflammation and tissue damage within affected organs [1]Mucocutaneous, musculoskeletal and renal involvement are frequently observed in patients with Systemic Lupus Erythematosus, reflecting the disease's propensity for multi-system affliction [2].

Lupus Nephritis is a prevalent and serious manifestation of Systemic Lupus Erythematosus contributing substantially to morbidity and mortality. Characterized by a heterogeneous clinical course, Lupus nephritis ranges from subclinical disease to a rapidly progressive trajectory leading to end-stage renal disease (ESRD) [3].

Renal biopsy is the cornerstone of Lupus Nephritis diagnosis. The tissue obtained is evaluated using light microscopy, immunofluorescence and electron microscopy, facilitating accurate diagnosis and classification of Lupus Nephritis. This histopathological assessment is often pivotal in establishing the diagnosis of Lupus nephritis [4].Elevated serum creatinine levels at the time of renal biopsy are associated with an increased risk of progression to renal failure, serving as a potent adverse prognostic indicator [5].

The prognostic factors for Lupus Nephritis are debated but poor outcomes are associated with several variables including male gender, black ethnicity, pre-pubertal onset, persistent hypertension, impaired renal function, nephrotic syndrome, anemia, class IV nephritis and high histological activity index scores [6].

Materials and Methods

Study design

A hospital based cross sectional study was conducted among 104 patients with Systemic Lupus Erythematosus (SLE) attending the Rheumatology outpatient department (OPD) and Medicine wards of Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur for a period of 2 (two) years from September 2019 to August 2021. The objective of the study was to determine the prevalence of Lupus Nephritis in adult patients of Systemic Lupus Erythematosus.

Ethical Clearance

The study was carried out after obtaining ethical approval from the Research Ethics Board, Regional Institute of Medical Sciences, Imphal

Study duration

The study was done over a period of 2 (two) year from September 2019 to August 2021.

Inclusion Criteria

  1. Age above 18 years

  2. Patients of both gender diagnosed with Systemic Lupus Erythematosus

  3. Those who gave consent to undergo the study

Exclusion Criteria

  1. Age less than 18 years

  2. Those not willing to take part in the study

Study tools

  1. A pre-defined proforma for collecting the socio-demographic characteristics, clinical and disease characteristics

  2. Urine sample was used to determine Lupus Nephritis in the study. The patients were requested to collect mid stream urine in urine vials. Urine collected was analysed in laboratory.

Study procedure

The participants were informed about the nature of the study which was fully explained in the participant information sheet and only those who agreed to undergo the study signed in the informed consent form. Their participation was completely voluntary and right to deny to participate in the study was reserved. Privacy and confidentiality was maintained at all cost for each participant.

Operational definitions

  1. Lupus nephritis: Urinary proteinuria >500 mg/24 hours and/or spot urine protein and creatinine ratio >0.5 and/or active urinary sediment or cast (>5 RBC/hpf, >5 WBC/hpf, casts) was used to diagnose Lupus Nephritis.

Statistical Analysis

The collected data was analysed using SPSS (Statistical Package for Social Sciences software) version 21.0. Microsoft word and Excel were used to generate graphs, tables etc. Descriptive statistics like frequency, percentage, mean, standard deviation and proportions were used. A probability value < 0.05 was considered as statistically significant.

Results

Table 1: Baseline characteristics of the study population
Characteristics Frequency (%)
Age in years<2021 - 3031 - 4041 - 50>50 8 (7.7)27 (26)31 (29.8)20 (19.2)18 (17.3)
GenderMaleFemale 4 (3.8)100 (96.2)
Duration of SLE<3 year3-5 years>5 years 26 (25)61 (58.7)17 (16.3)
ResidenceRuralUrban 28 (26.9)76 (73.1)

In our study, 104 patients with Systemic Lupus Erythematosus were included to assess the prevalence of Lupus nephritis. The baseline characteristics of the study population is listed in Table 1. The age of the study population ranged from 19 years to 64 years. The mean age of the study population was 37.95 ± 13.78 years. The most common age group of occurrence of Systemic Lupus Erythematosus in the study population was 31–40 years at 29.8%.

In the gender distribution, females at 96.2% were predominant compared to males at 3.8%. In our study, 58.7% patients had duration of Systemic Lupus Erythematosus for 3–5 years. The majority of the patients at 73.1% were residents of urban areas.

Table 2:Lupus Nephritis in the study population

Table
Characteristics Frequency (%)
Lupus NephritisPresentAbsent 30 (28.8)74 (71.2)
Age distribution of Lupus Nephritis<2021 - 3031 - 4041 - 50>50 4 (13.3)7 (23.3)11 (36.7)5 (16.7)3 (10)
Gender distribution of Lupus NephritisMaleFemale 1 (3.3)29 (96.7)
Duration of SLE with Lupus Nephritis<3 year3-5 years>5 years 6 (20)15(50)9 (30)

In our assessment of 104 patients with Systemic Lupus Erythematosus, 28.8% had Lupus Nephritis as per the American College of Rheumatology (ACR) criteria. The most common age group of occurrence of Lupus Nephritis was 31 – 40 years at 36.7% in the study population. Female gender predominance at 96.7% was noted among the Lupus Nephritis patients. 50% patients developed Lupus nephritis within 3–5 years of diagnosis of Systemic Lupus Erythematosus (Table 2).

Discussion

Systemic Lupus Erythematosus (SLE) is a multifaceted autoimmune disease marked by chronic immune complex formation, leading to diverse clinical manifestations and multi-organ involvement. The disease course is often dictated by renal involvement with Lupus Nephritis (LN) affecting approximately 50-70% of Systemic Lupus Erythematosus patients, underscoring its significance in disease prognosis and management [7].

Systemic Lupus Erythematosus exhibits a broad tropism affecting virtually any organ or tissue with clinical manifestations that vary considerably among patients. The interplay of genetic predisposition, environmental risk factors and hormonal influences contributes to the observed clinical heterogeneity [8,9].

The mean age of our study population was 37.95 ± 13.78 years, similar to the findings of a study done by Venishetty H et al10 with a reported mean age of 32.7 ± 10.7 years in Systemic Lupus Erythematosus patients. In contrast to the findings of our study, Satish S et al.,[11] reported a mean age of 28.05 ± 10.30 years in Systemic Lupus Erythematosus cases.

In our study, 96% patients were female with Systemic Lupus Erythematosus.A significant female predominance has been consistently observed in Systemic Lupus Erythematosus cases with female sex emerging as a major risk factor for disease development, highlighting a notable sex disparity in lupus susceptibility [12]. A pronounced gender disparity is evident in Systemic Lupus Erythematosus, with a male-to-female ratio of 1:9 [13].

Though Systemic Lupus Erythematosus can manifest across all age groups, it exhibits a predilection for individuals between 15 years to 45 years of age with peak incidence observed during this period [14]. The most common age group of occurrence of Lupus Nephritis in Systemic Lupus Erythematosus patients was 31 – 40 years in our study.

Proteinuria is a hallmark feature of Lupus Nephritis, serving as a key indicator of renal involvement. The presence and severity of proteinuria independently contribute to the risk of progressive renal function decline, emphasizing its significance as a prognostic marker and therapeutic target [15,16].

The American College of Rheumatology recommends performing a renal biopsy in Systemic Lupus Erythematosus patients meeting specific criteria, including 24-hour proteinuria, abnormal renal function and 24-hours proteinuria >0.5g accompanied by active urinary sediments [17].

In our study, the prevalence of Lupus Nephritis in patients with Systemic Lupus Erythematosus was 28.8% as per the American College of Rheumatology (ACR) criteria for Lupus Nephritis.Renal involvement is a common complication in Systemic Lupus Erythematosus with Lupus Nephritis presenting across a broad clinical spectrum ranging from mild proteinuria to rapidly progressive renal failure [17].

Conclusion

Our study highlights the prevalence of Lupus Nephritis in patients with Systemic Lupus Erythematosus. Lupus Nephritis presents across a broad clinical spectrum ranging from mild proteinuria to rapidly progressive renal failure. The healthcare providers should effectively foster strategies to mitigate the risk of Lupus Nephritis in Systemic Lupus Erythematosus patients so as to potentially improve outcomes for those at risk.

Declaration

Acknowledgement

The authors are grateful to the patients who participated in the study.

Conflict of Interest

None declared

Funding Statment

Nil

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