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OP0104 Lupus nephritis: contrasting clinical outcome during the last decade
  1. C Fiehn1,
  2. Y Hajjar1,
  3. R Waldherr2,
  4. K Andrassy3
  1. 1Department Internal Medicine V
  2. 2Clinic of Pathology, Heidelberg, Germany
  3. 3Section of Nephrology, University of Heidelberg

Abstract

Background According to Cameron (1999) 5-year renal survival of WHO class IV lupus nephritis (LN) after diagnosis and treatment is now 82%. It is claimed that when terminal renal failure (ERF) supervenes, it is within the first decade of follow-up.

Objectives As our recent experience is different, we evaluated the long-term renal outcome in patients with lupus nephritis treated in our institution in the last decade.

Methods During the last 10 years we followed 44 caucasians (35 females, 9 males, median age 40 years, range 18–73) with biopsy proven LN (WHO class II 5, III 2, IV 31, V 5, and VI 1). 15/44 patients had hypertension, 37/44 patients anti-DNA-ab (Farr test) (median 18, range 8–1493 U/ml), 41/44 positive ANA (median 1280, range 160–40960 titer), 44/44 proteinuria (20/44 with nephrotic proteinuria (NS) and 37/44 hematuria. Median creatinine on admission was 0.9 mg/dl, range (0.3–4.0), median haemoglobin 11.7 g/dl (range 8.2–14.3). All WHO classes were treated with glucocorticoids (1 mg/kg/day for 8–12 weeks, tapering off according to the clinical situation). WHO class IV was initially treated with 3 methylprednisolone boli (then 1 mg/kg/day) and cyclophosphamide (CP) (Austin scheme), sometimes supported by cyclosporine, azathioprine or mycophenolate mofetil. Hypertension and/or NS were treated with ACE inhibitors, hyperlipidemia with statins.

Results No patient died or attained ERF. Median creatinine was 1.1 mg/dl (range 0.5–5.4) after an median observation period of 39 month (range 1- 128). Impaired but stable renal function was observed in 12/44 patients (classes III 2, IV 9, V 1). Progression to renal failure was observed in 1 patient with uncontrolled hypertension. From renal histology only classes III and IV had adverse outcomes.

Conclusion We attribute improved outcome of LN in the last decade to earlier detection and therapy of LN and treatment of LN-flares with CP and steroid boli. Moreover better medical management particularly the consequent treatment of hypertension with ACE inhibitors may contribute to a favourable prognosis.

References

  1. Cameron JS. Lupus nephritis. J Am Soc Nephrol. 1999;10:413–35

  2. Austin HA, Boumpas DT, Vaughan EM, Balow JE. High-risk features of lupus nephritis: importance of race and histological factors in 166 patients. Nephrol Dial Transplant. 1995;10:1620–8

  3. Moroni G, Quaglini S, Maccario M, Banfi G, Ponticelli C. Nephritic flares are predictors of bad long-term renal outcome in lupus nephritis. Kidney Int. 1996;50:2047–53

  4. Ward MM, Studenski S. Clinical prognostic factors in lupus nephritis. The importance of hypertension and smoking. Arch Intern Med. 1992;152:2082–8

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