SLE patients Without Initial Lupus Nephritis at Risk of Adverse Renal and CV outcomes: Study
A new study published in the journal of Rheumatology showed that over time, people with systemic lupus erythematosus (SLE) who do not exhibit signs of lupus nephritis (LN) and have maintained kidney function upon diagnosis are nevertheless more vulnerable to poor renal outcomes, cardiovascular events, and death.
The chronic autoimmune illness known as SLE often affects the kidneys. Lupus nephritis is a severe symptom that raises the risk of CKD. Crucially, there is still a significant risk of progressive deterioration for newly diagnosed SLE patients who come with maintained renal function. Long before clinical symptoms or reductions in filtration rate become evident, underlying processes such as tubulointerstitial inflammation and glomerular scarring frequently take place.
This vulnerability to kidney damage is further increased by cardiovascular issues, antiphospholipid antibodies, and side effects from several immunosuppressive drugs. Thus, early detection of subclinical nephritis and rigorous, ongoing surveillance are vital. Therefore, this study examined the development of chronic kidney disease (CKD) in newly diagnosed SLE patients with maintained renal function and no concurrent LN.
A nationwide database analysis of newly diagnosed SLE patients from 2015 to 2023. Patients were matched by age, sex, and ethnicity to non-SLE controls if their estimated glomerular filtration rate (eGFR) upon diagnosis was more than 60 mL/min/1.73 m2. LN patients were not included. Incident CKD, which is defined as eGFR ≤60 mL/min/1.73 m2 after diagnosis, was the main outcome. All-cause mortality, major adverse cardiovascular events (MACE), and end-stage renal disease (ESKD) were secondary endpoints.
This study found 91,681 matched controls and 1,145 SLE patients with identical baseline eGFRs (103 vs. 104 mL/min/1.73 m2) and a median follow-up of 5.77 years. CKD (5.2% vs. 2.7%; HR 1.96, 95% CI 1.50-2.54), MACE (HR 1.63, 95% CI 1.31-2.04), ESKD (HR 3.13, 95% CI 1.38-7.08), and all-cause mortality (HR 4.52, 95% CI 3.71-5.50) were linked to SLE.
The groups' mean eGFR trajectories were comparable. The two biggest risk variables for CKD and ESKD were diabetes (HR 1.51, 95% CI 1.39-1.64) and hypertension (HR 2.72, 95% CI 2.42-3.07). Overall, long-term surveillance and adjustment of modifiable CKD risk variables are crucial since patients with SLE and intact kidney function at diagnosis, without LN, are more likely to experience poor renal outcomes, cardiovascular events, and death.
Source:
Sagy, I., Ben Shitrit, I., Abu-Shakra, M., Zeller, L., Bieber, A., Cohen-Hagai, K., Kivity, S., & Tayer-Shifman, O. E. (2026). Risk of chronic kidney disease in newly diagnosed systemic lupus erythematosus with preserved renal function: a national study. Rheumatology (Oxford, England). https://doi.org/10.1093/rheumatology/keag307
