Background and objective: Lupus nephritis is the strongest predictor of poor outcome in systemic lupus erythematosus. Up to 60% of patients develop renal involvement with 10- 20% progressing to end-stage renal disease. The objective of the meta-analysis was to determine prognostic factors of poor renal outcome in lupus nephritis patients. The findings of the study may provide a clearer indication of the likelihood of worsening state of renal function thus affect monitoring and therapeutic decisions.

Methodology: Two independent reviewers searched electronic databases from Pub Med and Science Direct. Predetermined criteria were used to include eligible studies. Pooled mean differences, odds ratios and 95% confidence intervals were computed using fixed-effect approach in Rev Man7®. Clinical, laboratory and renal biopsy prognostic factors were tested for heterogeneity and for overall effect. P-value <0.05 was considered statistically significant.

Results: Nine studies with a total 794 patients were included. Two hundred and seven had poor renal functional outcome which included deteriorating estimated glomerular filtration rate, progression to chronic kidney disease or end-stage renal disease and ESRD-related mortality. Male gender (OR 1.83; 95% CI 1.02-3.26), hypertension (OR 1.97; 95% CI 1.02- 3.81), nephrotic syndrome (OR 1.71; 95% CI 1.04-2.82) and high chronicity index on renal biopsy (OR 4.39; 95% CI 2.63- 7.33) were poor prognostic factors in lupus nephritis. Systolic blood pressure and proteinuria were significantly elevated in lupus nephritis patients with poor renal outcome.

Conclusion: The odds of having poor renal prognosis was increased in the presence of hypertension, nephrotic syndrome and high chronicity index on renal biopsy. The results of the study highlight the role of aggressive control of modifiable factors like hypertension and proteinuria, and the prognostic role of a kidney biopsy to minimize irreversible kidney damage. Lupus nephritis patients with poor prognostic factors merit closer monitoring and more aggressive treatment.

Keywords: prognostic factors, lupus nephritis

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