The Long-Term Clinical Outcome of 56 Patients with Biopsy-Proven Lupus Nephritis Followed at a Single Center

Abstract

We retrospectively evaluated the clinical outcome of 45 female and 11 male patients with biopsy-proven lupus nephritis, followed at our hospital between February 1974 and February 1990. In the majority signs of nephritis were present at the time systemic lupus erythematosus was diagnosed (range: -42-156 months) and the median time from onset of nephritis to biopsy was 2 months. The median follow-up from the time of the biopsy was 53.5 months (range: 2-192), the median age at biopsy 25 years and the median serum creatinine level 1.2 mg/dl. Initial renal biopsies had the following histopathological classes according to the World Health Organization criteria (n): I (2); II (10); III (10); IV (28); V (5); VI (1). Over the study period active episodes were treated with high-dose oral prednisone alone or combined with intravenous nitrogen mustard and oral chlorambucil (1974-75), azathioprine (1978-86), cyclophosphamide (1986-90) and/or plasma-exchange (1976-84). These strategies were based on literature data or multicenter studies in which we participated. Eight patients developed end-stage renal disease (ESRD) (median: 47 months post-biopsy; range: 20-120). In these, initial biopsies showed class IV in seven, and class V in one. Confounded risk factors for ESRD were class IV biopsy, male gender and serum creatinine level above 1.4 mg/dl. The calculated proportion without ESRD 5 years post-biopsy was 87% (95% confidence limits: 98-76%), and at 10 years 70% (95% confidence limits: 90-49%). Five patients (11.2%) died; causes of death were cerebrovascular accident (n = 2), cerebral lupus (n = 2) and S. aureus sepsis (n = 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Definition of risk factors for death, end stage renal disease, and thromboembolic events in a monocentric cohort of 338 patients with systemic lupus erythematosus

“…ESRD was found by Derksen et al in 14.3% of patients with biopsy proven lupus nephritis. 43 Stone reported about 10% of ESRD within all patients with SLE. 44 Derksen et al reported a higher prevalence of ESRD in men with lupus nephritis but not in men of the whole SLE cohort, 43 as we also found.…”

Characteristics and influence factors of pathologic transformation in the subclasses of class IV lupus nephritis

“…Activity and chronicity indices [5], plasma creatinine level [6], anemia [7], as well as male sex [8] have been found useful for to assess prognosis of lupus nephritis in some studies, but not in others [9,10]. One of the reasons for this discrepancy may be the weakening of the prognostic power of these parameters with the progression of lupus nephritis.…”

Prognosis in systemic lupus erythematosus

“…A number of studies suggest that men with nephritis are more likely to develop renal failure than are women [3,12,14,85]. Hypertension that does not respond to treatment may be a more useful marker than hypertension at presentation [49,80].…”