Journal
SEMINARS IN ARTHRITIS AND RHEUMATISM
Volume 41, Issue 5, Pages 642-651Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.semarthrit.2011.08.002
Keywords
lupus nephritis; membranous nephropathy; proliferative glomerulonephritis; patient survival; renal survival
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Objectives: The objective of this study was to evaluate the clinical features, course, outcome, and prognostic indicators in lupus membranous nephritis (LMN) and to compare data of pure LMN vs mixed forms. Methods: We retrospectively examined medical records and kidney biopsies of 103 patients with a diagnosis of LMN. Results: Sixty-seven patients had pure LMN and 36 had mixed forms. Patients with mixed LMN had more frequent nephrotic syndrome (66.6 vs 44.7%, P = 0.05), low C3 (83.3 vs 62.6%, P = 0.05) and C4 (80.5 vs 52.2%, P = 0.005), anti-DNA positivity (86.0 vs 62.6%, P = 0.03), and a tendency toward a lower creatinine clearance (93 +/- 29 vs 112 +/- 50 mL/min, P = 0.07). Moreover, mixed membranous nephritis had a higher activity and chronicity index (6.5 +/- 2.1 vs 1.4 +/- 2.03, P = 0.005 and 2.4 +/- 1.7 vs 1.4 +/- 1.8, P = 0.0001, respectively). Methylprednisolone pulses and immunosuppressive therapy were more often used in patients with mixed forms (86.1 vs 60.6%, P = 0.016 and 83.3 vs 57.5%, P = 0.008, respectively). After a mean follow-up of 156.5 +/- 104.5 months, there was no difference in the 2 subgroups concerning the number of patients achieving remission and patient/renal survival (94.5 vs 94.0% and 85.8 vs 86% at 10 years). At multivariate analysis, serum creatinine at presentation (P = 0.0013), chronicity index (P = 0.007), failure of achieving remission (P = 0.000001), and occurrence of nephritic flares (P = 0.00167) were independent predictors of chronic renal insufficiency. Conclusions: Despite the differences in clinical and histological presentation, a therapy tailored on the grounds of clinical and histological features may reduce the differences in the outcome of white patients with mixed and pure membranous nephritis. Published by Elsevier Inc. Semin Arthritis Rheum 41:642-651
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