Clinical and Immunological Determinants of Glomerular Filtration Rate in Iraqi Patients with Systemic Lupus Erythematosus
DOI:
https://doi.org/10.64554/nujms.2026.2.1.4Keywords:
Chronic kidney disease; Glomerular filtration rate; Lupus nephritis; Serum creatinine; Systemic lupus erythematosusAbstract
Objective: To identify clinical, immunological, and cardiometabolic factors associated with estimated glomerular filtration rate (eGFR) in Iraqi patients with systemic lupus erythematosus (SLE) and to describe the distribution of chronic kidney disease (CKD) stages in this group.
Methods: This cross-sectional study included 44 patients with SLE attending Baghdad Teaching Hospital, Baghdad, Iraq, between September 2023 and March 2024. Age, sex, body mass index (BMI), blood pressure, antinuclear antibody (ANA) level, erythrocyte sedimentation rate (ESR),white blood cell (WBC) count, and serum creatinine (SCR) were recorded, and eGFR was calculated with the CKD-EPI 2021 equation. Group comparisons, correlation analysis, and multiple linear regression were performed.
Results: Most patients were female (88.6%), and the mean age was 42.05 ± 12.87 years. Five patients (11.4%) had CKD (eGFR <60 mL/min/1.73 m²) and eight (18.2%) had hypertension. Patients with CKD had higher SCR than those without CKD (p < 0.001). eGFR correlated negatively with age (Spearman ρ = −0.547, p < 0.001) and SCR (ρ = −0.865, p < 0.001). In multiple regression, age was independently associated with lower eGFR (β = −1.475, p < 0.001). ANA was also associated with eGFR (β = 1.579, p = 0.002), but this association depended on a single patient and was no longer significant when that patient was excluded. BMI was not associated with eGFR. The model explained 42.6% of the variance in eGFR (adjusted R² = 0.331). ESR was higher in female than in male patients (p = 0.036).
Conclusions: Older age was the factor most consistently associated with lower eGFR, whereas BMI, blood pressure, and inflammatory markers were not. Routine monitoring of SCR, eGFR, and blood pressure, with closer follow-up of older patients, may support early detection of renal impairment. Larger prospective studies are needed to confirm these findings.
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References
1. Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR
recommendations for the management of systemic lupus erythematosus. Ann Rheum
Dis. 2019;78(6):736-45. https://doi.org/10.1136/annrheumdis-2019-215089
2. Morand EF, Furie R, Tanaka Y, et al. Trial of anifrolumab in active systemic lupus
erythematosus. N Engl J Med. 2020;382(3):211-21.
https://doi.org/10.1056/NEJMoa1912196
3. Almaani S, Meara A, Rovin BH. Update on lupus nephritis. Clin J Am Soc Nephrol.
2017;12(5):825-35. https://doi.org/10.2215/CJN.05780616
4. Fanouriakis A, Tziolos N, Bertsias G, et al. Update on the diagnosis and management
of systemic lupus erythematosus. Ann Rheum Dis. 2021;80(1):14-25.
https://doi.org/10.1136/annrheumdis-2020-218272
5. Inker LA, Eneanya ND, Coresh J, et al. New creatinine- and cystatin C-based equations
to estimate GFR without race. N Engl J Med. 2021;385(19):1737-49.
https://doi.org/10.1056/NEJMoa2102953
6. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular
filtration rate from serum creatinine: a new prediction equation. Ann Intern Med.
1999;130(6):461-70. https://doi.org/10.7326/0003-4819-130-6-199903160-00002
7. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO
2012 clinical practice guideline for the evaluation and management of chronic kidney
disease. Kidney Int Suppl. 2013;3(1):1-150. https://doi.org/10.1038/kisup.2012.73
8. Anders HJ, Saxena R, Zhao MH, et al. Lupus nephritis. Nat Rev Dis Primers.
2020;6(1):7. https://doi.org/10.1038/s41572-019-0141-9
9. Urowitz MB, Ibañez D, Gladman DD, et al. Atherosclerotic vascular events in a single
large lupus cohort: prevalence and risk factors. J Rheumatol. 2007;34(1):70-5.
https://doi.org/10.3899/jrheum.070093
10. Ippolito A, Petri M. An update on mortality in systemic lupus erythematosus. Clin Exp
Rheumatol. 2008;26(5 Suppl 51):S72-9.
11. Hochberg MC. Updating the American College of Rheumatology revised criteria for
the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40(9):1725.
https://doi.org/10.1002/art.1780400928
12. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the
management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104.
https://doi.org/10.1093/eurheartj/ehy339
13. Feldman CH, Hiraki LT, Liu J, et al. Epidemiology and sociodemographics of systemic
lupus erythematosus and lupus nephritis among US adults with Medicaid coverage,
2000-2004. Arthritis Rheum. 2013;65(3):753-63. https://doi.org/10.1002/art.37795
14. Tektonidou MG, Dasgupta A, Ward MM. Risk of end-stage renal disease in patients
with lupus nephritis, 1971-2015: a systematic review and Bayesian meta-analysis.
Arthritis Rheumatol. 2016;68(6):1432-41. https://doi.org/10.1002/art.39594
15. Rule AD, Amer H, Cornell LD, et al. The association between age and nephrosclerosis
on renal biopsy among healthy adults. Ann Intern Med. 2010;152(9):561-7.
https://doi.org/10.7326/0003-4819-152-9-201005040-00004
16. Pisetsky DS. Anti-DNA antibodies—quintessential biomarkers of SLE. Nat Rev
Rheumatol. 2016;12(2):102-10. https://doi.org/10.1038/nrrheum.2015.151
17. Pisetsky DS, Lipsky PE. New insights into the role of antinuclear antibodies in systemic
lupus erythematosus. Nat Rev Rheumatol. 2020;16(10):565-79.
https://doi.org/10.1038/s41584-020-0480-7
18. Kidney Disease: Improving Global Outcomes (KDIGO) Lupus Nephritis Work Group.
KDIGO 2024 clinical practice guideline for the management of lupus nephritis. Kidney
Int. 2024;105(1S):S1-69. https://doi.org/10.1016/j.kint.2023.09.002
19. Rovin BH, Adler SG, Barratt J, et al. KDIGO 2021 clinical practice guideline for the
management of glomerular diseases. Kidney Int. 2021;100(4S):S1-276.
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