Background Diffuse Proliferative Glomerulonephritis (DPGN) is considered one of the most important factors influencing the long term prognosis of SLE patients. Renal flares are considered important risk factors influencing the outcome of renal involvement.
Objectives The aim of this study was to evaluate the occurrence of renal flares and their prognostic significance for the renal outcome in a population of SLE patients with DPGN.
Methods The clinical, laboratory and histological data of 91 SLE patients (8 males and 83 females) followed at the Rheumatology Unit of the University of Pisa, were retrospectively evaluated.
Results Fourty-nine patients (54%) presented a renal flare a mean of 42 months after the renal biopsy. Twenty-eight flares (57%) were proteinuric, twenty-one (43%) were nephritic flares. A young age at the time of the renal biopsy and treatment with steroids alone, were significantly correlated with the occurrence of renal flares, furthermore a high Activity Index (AI >9) and the presence of karyorrhexis on renal histology were correlated with the occurrence of nephritic flares. A poor renal outcome occurred in 27% of the patients; serum creatinine levels at the time of renal biopsy, the presence of karyorrhexis and the composite Chronicity Index (CI) as well as all of its component on renal histology, the number of renal flares (both proteinuric and nephritic), the occurrence of nephritic flares and early proteinuric flares (i.e. in the first 17 months after the renal biopsy), were correlated with a poor renal outcome.
Conclusion In conclusion, the analysis of our patients has showed that nephritic flares and early proteinuric flares are important risk factors for the occurrence of a poor renal outcome. Since young patients with an elevated AI and karyorrhexis are at increased risk for renal flares, they should be candidated for a more aggressive and prolonged treatment.
Moroni G, et al. Kidney Int. 1996;50:2047–53
Ponticelli C, et al. Lupus 1998;7:635–8
Ciruelo, et al. Arthritis Rheum. 1996;39:2028–34