Skip to main content

Advertisement

SpringerLink
Log in

Late onset lupus nephritis: analysis of clinical manifestations and renal pathological features in Chinese patients

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

The objectives of the study are to analyze the clinical and pathological features of 35 Chinese patients with late onset lupus nephritis (LN) in a single center. All the LN patients followed-up in our lupus clinic center from 1986 to 2008 were enrolled in this retrospective study. Thirty-five patients with a disease onset beyond the age of 50 years were identified. One hundred systemic lupus erythematosus (SLE) patients who had their disease onset before the age of 50 years were randomly recruited as controls. All of them received renal biopsy. The histological classifications were categorized according to 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification. All of patients were Han Chinese. The mean age of onset of SLE for late onset and the control groups were 55.7 ± 6.5 years (range: 50–76) and 28.9 ± 7.6 years (range:18–48).The female to male ratio was smaller in the late onset SLE group, 2.9–1, compared with 7.3–1 in the control. The patients with hypertension in late onset LN were much more than that in control group. The renal histological classes showed no significant difference between the two groups. Classes IV, V, IV + V were common in late onset LN patients. There were no significant differences in extra renal manifestations except for a lower prevalence of malar rash, a higher leukopenia and skin vasculitis in the late onset patients. As to the immunological features, serum antineutrophil cytoplasmic antibodies (ANCA) and SSA positivity were more common in late onset LN patients. The patients with hypertension in late onset LN were much more than that in control group. The renal histological classes showed no significant difference between the two groups. Leukopenia and serum ANCA were more common. The results suggest a more severity of the disease in late onset LN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ward MM, Polisson PR (1989) A meta analysis of the clinical manifestations of older onset systemiclupus erythematosus. Arthritis Rheum 32:1226–1232

    Article  PubMed  CAS  Google Scholar 

  2. Hahn BH, Tsao BP (1997) Antibodies to DNA. In: Wallance DJ, Hahn BH (eds) Dubois’ lupus erythematosus. Williams and Wilkins, Baltimore, pp 407–422

    Google Scholar 

  3. Antolin J, Amerigo MJ et al (1995) Systemic lupus erythematosus: clinical manifestations and immunological parameters in 194 patients. Subgroup classification of SLE. Clin Rheumatol 14(6):678–685

    Article  PubMed  CAS  Google Scholar 

  4. Baker SB, Rovira JR et al (1979) Late onset systemic lupus erythematosus. Am J Med 66(5):727–732

    Article  PubMed  CAS  Google Scholar 

  5. Boddaert J, Huong DL et al (2004) Late-onset systemic lupus erythematosus: a personal series of 47 patients and pooled analysis of 714 cases in the literature. Medicine (Baltimore) 83(6):348–359

    Article  Google Scholar 

  6. Appenzeller S, Pereira DA et al (2008) Greater accrual damage in late-onset systemic lupus erythematosus: a long-term follow-up study. Lupus 17(11):1023–1028

    Article  PubMed  CAS  Google Scholar 

  7. Padovan M, Govoni M, Castellino G, Rizzo N, Fotinidi M, Trotta F (2007) Late onset systemic lupus erythematosus: no substantial differences using different cut-off ages. Rheumatol Int 27:735–741

    Article  PubMed  Google Scholar 

  8. Mok CC, Mak A, Chu WP, To CH, Wong SN (2005) Long-term survival of Southern Chinese patients with systemic lupus erythematosus: a prospective study of all age-groups. Williams and Wilkins 84:218–224

    Google Scholar 

  9. Mak A, Mok CC, Chu WP, To CH, Wong SN, Au TC (2007) Renal damage in systemic lupus erythematosus: a comparative analysis of different age groups. Lupus 16:28–34

    Article  PubMed  CAS  Google Scholar 

  10. Formiga F, Moga I et al (1999) Mild presentation of systemic lupus erythematosus in elderly patients assessed by SLEDAI. SLE disease activity index. Lupus 8(6):462–465

    Article  PubMed  CAS  Google Scholar 

  11. Baker SB, Rovira JR, Campion EW, Mills JA (1979) Late on-set systemic lupus erythematosus. Am J Med 66:727–732

    Article  PubMed  CAS  Google Scholar 

  12. Rovensky J, Tuchynova A (2008) Systemic lupus erythematosus in the elderly. Autoimmun Rev 7:235–239

    Article  PubMed  CAS  Google Scholar 

  13. Ho CTK, Mok CC, Lau CS, Wong RW (1998) Late onset systemic lupus erythematosus in southern Chinese. Ann Rheum Dis 57:437–440

    Article  PubMed  CAS  Google Scholar 

  14. Bertoli AM, Alarcon GS et al (2006) Systemic lupus erythematosus in a multiethnic US cohort. XXXIII. Clinical [corrected] features, course, and outcome in patients with late-onset disease. Arthritis Rheum 54(5):1580–1587

    Article  PubMed  Google Scholar 

  15. Boey ML (1998) Systemic lupus erythematosus in Singapore. Ann Acad Med Singapore 27(1):35–41

    PubMed  CAS  Google Scholar 

  16. Karoubi Nordon E, Hayem G, Mentre F, Palazzo E, Legrain S, Meyer O, Raveaud P (2007) Letter to the editor: late onset systemic lupus erythematosus: a new approach. Lupus 16:1011–1014

    Article  PubMed  CAS  Google Scholar 

  17. Koh ET, Boey ML (1994) Late onset lupus: a clinical and immunological study in a predominantly Chinese population. J Rheumatol 21(8):1463–1467

    PubMed  CAS  Google Scholar 

  18. Shaikh SK, Wang F (1995) Late-onset systemic lupus erythematosus: clinical and immunological characteristics. Med J Malaysia 50(1):25–31

    PubMed  CAS  Google Scholar 

  19. Mak SK, Lam EK et al (1998) Clinical profile of patients with late-onset SLE: not a benign subgroup. Lupus 7(1):23–28

    Article  PubMed  CAS  Google Scholar 

  20. Sayarlioglu M, Cefle A et al (2005) Characteristics of patients with late onset systemic lupus erythematosus in Turkey. Int J Clin Pract 59(2):183–187

    Article  PubMed  CAS  Google Scholar 

  21. Steinberg AD, Melez KA et al (1979) Approach to the study of the role of sex hormones in autoimmunity. Arthritis Rheum 22(11):1170–1176

    Article  PubMed  CAS  Google Scholar 

  22. Bynoe MS, Grimaldi CM et al (2000) Estrogen up-regulates Bcl-2 and blocks tolerance induction of naive B cells. Proc Natl Acad Sci U S A 97(6):2703–2708

    Article  PubMed  CAS  Google Scholar 

  23. Chang DM, Lan JL et al (2002) Dehydroepiandrosterone treatment of women with mild-to-moderate systemic lupus erythematosus: a multicenter randomized, double-blind, placebo-controlled trial. Arthritis Rheum 46(11):2924–2927

    Article  PubMed  CAS  Google Scholar 

  24. Jungers P, Dougados M et al (1982) Effect of hormonal contraception on the course of lupus nephropathy. Nouv Presse Med 11(51):3765–3768

    PubMed  CAS  Google Scholar 

  25. Jungers P, Liote F et al (1986) Hormonal modulation in disseminated lupus erythematosus: the preliminary results with danazol and cyproterone acetate. Ann Med Interne (Paris) 137(4):313–319

    CAS  Google Scholar 

  26. Mok CC, Lau CS et al (1999) Do flares of systemic lupus erythematosus decline after menopause? Scand J Rheumatol 28(6):357–362

    Article  PubMed  CAS  Google Scholar 

  27. Mok CC, Lau CS et al (1998) Safety of hormonal replacement therapy in postmenopausal patients with systemic lupus erythematosus. Scand J Rheumatol 27(5):342–346

    Article  PubMed  CAS  Google Scholar 

  28. Mok CC, Lau CS et al (2001) Use of exogenous estrogens in systemic lupus erythematosus. Semin Arthritis Rheum 30(6):426–435

    Article  PubMed  CAS  Google Scholar 

  29. Sanchez-Guerrero J, Liang MH et al (1995) Postmenopausal estrogen therapy and the risk for developing systemic lupus erythematosus. Ann Intern Med 122(6):430–433

    PubMed  CAS  Google Scholar 

  30. Mok CC, Wong RW et al (1999) Ovarian failure and flares of systemic lupus erythematosus. Arthritis Rheum 42(6):1274–1280

    Article  PubMed  CAS  Google Scholar 

  31. Kanda N, Tsuchida T et al (1999) Estrogen enhancement of anti-double-stranded DNA antibody and immunoglobulin G production in peripheral blood mononuclear cells from patients with systemic lupus erythematosus. Arthritis Rheum 42(2):328–337

    Article  PubMed  CAS  Google Scholar 

  32. Maddison PJ (1987) Systemic lupus erythematosus in the elderly. J Rheumatol Suppl 14 Suppl 13:182–187

    Google Scholar 

  33. Rovensky J, Tuchynova A (2008) Systemic lupus erythematosus in the elderly. Autoimmun Rev 7(3):235–239

    Article  PubMed  CAS  Google Scholar 

  34. Garcia-Carrasco M, Ramos-Casals M et al (2002) Primary Sjogren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore) 81(4):270–280

    Article  Google Scholar 

  35. Jennette JC, Wilkman AS et al (1989) Anti-neutrophil cytoplasmic autoantibody-associated glomerulonephritis and vasculitis. Am J Pathol 135(5):921–930

    PubMed  CAS  Google Scholar 

  36. Gross WL (1995) Antineutrophil cytoplasmic autoantibodies, autoantigens, and systemic vasculitis. Apmis 103(2):81–97

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Research Institute of Nephrology, Jingling Hospital, Nanjing University School of Medicine, 210002, Nanjing, China

    Zheng Tang, Dongmei Chen, Shengmei Yang, Haitao Zhang, Weixin Hu, Zhihong Liu & Leishi Li

Authors
  1. Zheng Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dongmei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shengmei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haitao Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Weixin Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhihong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Leishi Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zheng Tang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tang, Z., Chen, D., Yang, S. et al. Late onset lupus nephritis: analysis of clinical manifestations and renal pathological features in Chinese patients. Rheumatol Int 31, 1625–1629 (2011). https://doi.org/10.1007/s00296-010-1536-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-010-1536-9

Keywords

Search

Navigation