Markers of severity and risk for end-stage renal disease (ESRD) in biopsy-proven proliferative lupus nephritis
| Nephritis class | Adverse renal histology* | Impaired renal function and/or severe proteinuria† | Response to immunosuppressive therapy‡ | |
|---|---|---|---|---|
| Mild disease | Focal proliferative | No | No | NA |
| Moderately severe disease | Focal proliferative | No | No | Partial or no response |
| Focal proliferative | Either present | NA | ||
| Diffuse proliferative | No | No | NA | |
| Severe disease | Diffuse proliferative classified as moderately severe | NA | NA | Partial or no response |
| Focal or diffuse proliferative | Yes | Yes | NA | |
| Mixed proliferative and membranous | NA | NA | NA | |
| Rapidly progressive glomerulonephritis | NA | NA | NA |
This classification is based upon findings of longitudinal observational studies, retrospective analyses of RCTs or clinical cohorts with regard to histological, clinical or serological factors associated with development of ESRD. The prognostic value of some of these factors in the context of mycophenolate mofetil treatment needs to be defined.
↵* Crescents and/or fibrinoid necrosis affecting >25% of glomeruli; glomerular sclerosis, tubular atrophy or chronicity index >4; or chronicity index >3 and activity index >10.
↵† Increase in serum creatinine or reduction in estimated glomerular filtration rate (calculated by the Cockcroft-Gault or the Modification of Diet in Renal Disease formula) by >25%; proteinuria >4 g/24 h.
↵‡ Assessed after 6 months of therapy.19,–,21
NA, not applicable.