Table 2

Markers of severity and risk for end-stage renal disease (ESRD) in biopsy-proven proliferative lupus nephritis

Nephritis classAdverse renal histology*Impaired renal function and/or severe proteinuriaResponse to immunosuppressive therapy
Mild diseaseFocal proliferativeNoNoNA
Moderately severe diseaseFocal proliferativeNoNoPartial or no response
Focal proliferativeEither presentNA
Diffuse proliferativeNoNoNA
Severe diseaseDiffuse proliferative classified as moderately severeNANAPartial or no response
Focal or diffuse proliferativeYesYesNA
Mixed proliferative and membranousNANANA
Rapidly progressive glomerulonephritisNANANA
  • 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.