P SUBRAMANI1,2, CY YEAP2, S THOMAS1, B PAWAR1, S CHERIAN1,2, S BRADY3, W MAJONI2,4,5
1Alice Springs Hospital, Div. of Medicine, Dept. of Nephrology, Alice Springs, NT; 2Royal Darwin Hospital, Div. of Medicine, Dept. of Nephrology, Darwin, NT; 3Alice Springs Hospital, Div. of Medicine; 4Flinders Medical School, NT Medical Program; 5Menzies School of Health Research, NT
Aim: To analyse the prevalence, treatment, outcome and challenges of lupus nephritis (LN) in the Northern Territory
Background: There is a high incidence of systemic lupus erythematous amongst Indigenous Australians with rates of LN being reported as high as 52%. A recent study in Central Australia demonstrated poor outcomes of LN in this population despite advances in treatment, presumably due to disadvantage across a range of socioeconomic indicators including education, housing and employment. Unfortunately, direct comparison with non-Indigenous Australians proved difficult due to small sample size. Here we aim to expand on the previous study by analyzing all cases of LN in the Northern Territory (NT) from 1999 to December 2016.
Method: The electronic medical records of all patients with biopsy proven LN at Royal Darwin Hospital and Alice Springs Hospital between 1999 and December 2016 were reviewed.
Results: There were 51 patients with LN, 36 were Indigenous. The majority of patients had class III or IV LN, with 13 patients demonstrating features of class V LN. The majority of patients with Class III or IV LN were commenced on the current recommended induction regime of mycophenolate or cyclophosphamide plus glucocorticoid. A higher incidence of serious infective complications was observed in the Indigenous group. 9 patients, 8 of who were Indigenous progressed to end stage kidney disease. There were 6 deaths, all Indigenous.
Conclusion: Despite advances in treatment, outcomes of LN in the Indigenous population in the NT continue to lag behind non-Indigenous peers. Whilst socioeconomic status may play an important role in these differences, a closer study to identify modifiable social and/or biological determinants of outcome is necessary in order to bridge the gap.