Disease characteristics and outcomes of lupus nephritis in Saudi Arabia: A systematic review

Objective Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus (SLE). Existing data on LN in Saudi Arabia are primarily retrospective and derived from single centers. Therefore, this systematic review presents a unique and comprehensive analysis of the disease characteristics and outcomes of LN in Saudi Arabia. Method A systematic search of MEDLINE, ScienceDirect, Embase, Cochrane, and PubMed databases was conducted up to April 2024. Eligible articles reporting on LN in Saudi Arabia were included, and disease characteristics and outcomes were analyzed. Results A total of 36 studies met the inclusion criteria. The prevalence of LN among SLE patients in Saudi Arabia ranged from 19% to 55%, with biopsy-proven LN reported in 11% to 42.7% of cases. Females accounted for 66% to 94.9% of patients, with a mean age at diagnosis between 23.8 and 39.7 years. Hypertension was present in 45.8% to 62.9% of patients, with nephrotic-range proteinuria in 20.7% to 58.5% and mean serum creatinine levels between 60 and 112.68 µmol/L. Class IV LN was the most common histopathological finding, occurring in up to 72% of cases. Complete remission was achieved in up to 81.5% of patients within 12 months, though lower remission rates were observed in those with proliferative LN. End-stage renal disease (ESRD) rates ranged from 5.5% to 30.7%, with proliferative LN, older age, and hypertension being significant predictors of progression to ESRD. Five-year survival rates ranged from 92% to 96%, while 10-year survival reached 95%. Infection and renal failure were the leading causes of mortality. Conclusion LN is highly prevalent in lupus Saudi patients, with Class IV LN being the most common and associated with poor outcomes. Although survival has improved, many patients still progress to ESRD. Prospective trials are needed to evaluate outcomes in the current era of biological therapies.