Are there gender differences in the prognosis and treatment of lupus nephritis?
SLE is much more common in female patients. The effect of increased estrogen has been hypothesized to explain these gender differences.
Although less common, several studies have demonstrated a relatively higher prevalence of kidney disease in male patients.
In a cohort of 315 patients including 45 males, the male patients had lower remission rates, higher relapse rates, and worse long-term kidney outcomes.
Patient survival is worse in African American patients with SLE as compared with other subgroups. Lupus nephritis is almost twice as frequent in African American patients and carries a poor kidney prognosis.
The incidence of ESKD is up to sevenfold higher among African Americans than in any other subgroup. Predictors of ESKD in African American patients include high levels of serum creatinine, the presence of anti-Ro antibodies, and severe segmental lesions on biopsy.
Studies have also shown that Hispanic patients have worse outcomes as compared with non-Hispanic Caucasian patients.
In the Aspreva Lupus Management Study, there were differences in the treatment (induction) response across racial and ethnic groups.
Specifically, more African American and Hispanic patients responded to MMF than to IV cyclophosphamide. Asian and Caucasian patients showed similar response rates to both MMF and IV cyclophosphamide.
