Outcomes of membranous and proliferative lupus nephritis – analysis of a single-centre cohort with more than 30 years of follow-up

Abstract

Objectives To compare membranous lupus nephritis (MLN) and proliferative lupus nephritis (PLN) with respect to survival, demographic, clinical and laboratory characteristics; and to investigate predictors of renal and patient survival. Methods Single-centre retrospective observational study. Patients with biopsy-proven PLN, MLN and mixed lupus nephritis were included. Groups were compared using appropriate statistical tests and survival was analysed through the Kaplan-Meier method. Cox regression analysis was performed to investigate predictors of renal and patient survival. Results A total of 187 patients with biopsy-proven lupus nephritis (135 with PLN, 38 with MLN and 14 with mixed LN) were followed for up to 42 years (median 12 years). There was a higher proportion of MLN amongst Afro-Caribbeans than amongst Caucasians (31% vs 15%, P = 0.010). Patients with MLN had significantly lower anti-dsDNA antibodies (P = 0.001) and higher C3 levels (P = 0.018) at diagnosis. Cumulative renal survival rates at 5, 10, 15 and 20 years were 91, 81, 75 and 66% for PLN and 100, 97, 92 and 84% for MLN, respectively (P = 0.028). Cumulative patient survival at 5, 10, 15 and 20 years was 94, 86, 80 and 76%, with no difference between PLN and MLN. Urinary protein-creatinine ratio above 42 mg/mmol and eGFR below 76 ml/min/1.73 m2, one year after the diagnosis of LN, were the strongest predictors of progression to end-stage renal disease. eGFR below 77 ml/min/1.73 m2, at one year, development of end-stage renal disease and Afro-Caribbean ethnicity were associated with higher mortality. Conclusion Patients with MLN and PLN differ significantly regarding serological profiles and renal survival, suggesting different pathogenesis. Renal function at year one predicts renal and patient survival.

Dissecting the histological features of lupus nephritis highlights new common patterns of injury in class III/IV

“…Our results showed higher values of CI in mixed as compared with isolated III/IV classes, suggesting that the presence of a concurrent class V can worsen the chronic changes of the kidney. This is in line with the most recent evidence in the literature pointing out a worse outcome of mixed as compared with ‘pure’ cases 13 14. Most interestingly, an alternative clustering for pure focal/diffuse classes was found after supervised and unsupervised analysis, with a dichotomous subdivision in MPGN-like and vasculitis-like forms based on morphological features.…”

Response to therapy at 6 months predicts long-term renal outcome in lupus nephritis with poor kidney function

“…Specifically, proteinuria after 12 months of treatment has been recognised as a better predictor than the baseline proteinuria in multiple studies of patients with LN. [21][22][23][24] In our study, the medium proteinuria levels at baseline and 6 months were significantly higher in the ESRD group (table 1). However, proteinuria level at 6 months was not selected by the LASSO regression model, which was also validated by receiver operating characteristic (ROC) curves.…”

Secondary Membranous Nephropathy. A Narrative Review

“…Only few studies reported the long-term outcome of LMN. Progression to ESRD is slow and 72-97% of patients are still alive with kidney functioning at 10 years (86)(87)(88)(89)(90). Renal prognosis is largely influenced by the development of renal flares and transformation to proliferative disorders.…”