Abstract
Introduction: Lupus nephritis (LN) represents one of the most severe manifestations of systemic lupus erythematosus (SLE). Although SLE predominantly affects females, male patients often demonstrate more aggressive disease and worse renal outcomes. The impact of lupus anticoagulant (LA) positivity on LN remission among male individuals, remains insufficiently studied.
Objectives: To describe characteristics of male patients with LN and evaluate differences in clinical features and remission outcomes between patients with positive lupus anticoagulant (LNpLA) and those without lupus anticoagulant (LNnoLA).
Patients and Methods: In a retrospective observational study, adult male patients with SLE and biopsy-proven LN followed at Dubai hospital, a tertiary referral center in the UAE, between 2009 and 2024 were retrospectively analyzed. Clinical features, kidney biopsy findings, treatments, and outcomes were evaluated. Continuous variables were analyzed using independent T-test or Mann–Whitney U test, and categorical variables using χ² test or Fisher’s exact test. Statistical significance was defined as P<0.05.
Results: Thirty-two male patients were included (mean age 42±12 years), with LA positivity identified in 28% (n=9). Constitutional symptoms were the most common presentation, while class IV LN was the predominant histologic lesion. Baseline demographic characteristics and renal function were comparable between LNpLA and LNnoLA groups. In addition, antinuclear antibody (ANA) and anti-dsDNA positivity were observed in 81% and 69% of patients respectively. Moreover, LNpLA patients demonstrated higher prevalence of antiphospholipid antibodies and nephrotic-range proteinuria. Treatment regimens were comparable between groups. Renal remission occurred significantly less frequently in LNpLA compared with LNnoLA patients (22% versus 56%, P<0.05).
Conclusion: Among male patients with LN, LA positivity was associated with a reduced likelihood of renal remission. These findings support a potential role for antiphospholipid autoimmunity as a prognostic factor in male LN and may have implications for risk stratification and therapeutic decision-making, although larger prospective studies are needed to confirm and further define this association.