Skip to main content
Log in

Predictive value of remission status after 6 months induction therapy in patients with proliferative lupus nephritis: a retrospective analysis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

The objective of this study was to evaluate whether remission status after completion of induction therapy can be used to predict long-term renal outcomes, including renal relapse and chronic renal failure (CRF) in patients with proliferative lupus nephritis (LN). Of 201 patients with biopsy proven LN between 1998 and 2008, 117 were reviewed. Fifty nine (50.4%), 33 (28.2%), and 25 (21.4%) were assigned to the complete remission (CR), partial remission (PR), and non-remission (NR) groups, respectively. The 24-h urinary protein level was significantly lower in the CR than in the PR and NR groups. Induction therapy after the first detection of nephritis signs was initiated earlier in the CR than in the PR and NR groups. During follow-up, 36 (39.1%) patients suffered relapse. Multivariate analysis showed that longer latency period and a lack of CR were independent predictors of renal relapse. Seventeen (14.5%) patients experienced CRF. Multivariate analysis showed that higher baseline creatinine concentration and a lack of CR after induction therapy were independent predictors of CRF. We found that renal outcomes were related to remission status after 6 months induction therapy in patients with proliferative LN. Further, poor outcomes were associated with delayed intervention and higher creatinine concentration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Cameron JS (1999) Lupus nephritis. J Am Soc Nephrol 10:413–424

    PubMed  CAS  Google Scholar 

  2. Martins L, Rocha G, Rodrigues A, Santos J, Vasconcelos C, Correia J, Farinha F, Almeida I, Barbosa P, Guimaraes S (2002) Lupus nephritis: a retrospective review of 78 cases from a single center. Clin Nephrol 57:114–119

    PubMed  CAS  Google Scholar 

  3. MacGowan JR, Ellis S, Griffiths M, Isenberg DA (2002) Retrospective analysis of outcome in a cohort of patients with lupus nephritis treated between 1977 and 1999. Rheumatology (Oxford) 41:981–987

    Article  CAS  Google Scholar 

  4. Appel GB, Cohen DJ, Pirani CL, Meltzer JI, Estes D (1987) Long-term follow-up of patients with lupus nephritis. A study based on the classification of the World Health Organization. Am J Med 83:877–885

    Article  PubMed  CAS  Google Scholar 

  5. Austin HA 3rd, Boumpas DT, Vaughan EM, Balow JE (1994) Predicting renal outcomes in severe lupus nephritis: contributions of clinical and histologic data. Kidney Int 45:544–550

    Article  PubMed  Google Scholar 

  6. Contreras G, Pardo V, Cely C, Borja E, Hurtado A, De La Cuesta C, Iqbal K, Lenz O, Asif A, Nahar N, Leclerq B, Leon C, Schulman I, Ramirez-Seijas F, Paredes A, Cepero A, Khan T, Pachon F, Tozman E, Barreto G, Hoffman D, Almeida Suarez M, Busse JC, Esquenazi M, Esquenazi A, Garcia Mayol L, Garcia Estrada H (2005) Factors associated with poor outcomes in patients with lupus nephritis. Lupus 14:890–895

    Article  PubMed  CAS  Google Scholar 

  7. Arce-Salinas CA, Villa AR, Martinez-Rueda JO, Munoz L, Cardiel MH, Alcocer-Varela J, Alarcon-Segovia D (1995) Factors associated with chronic renal failure in 121 patients with diffuse proliferative lupus nephritis: a case-control study. Lupus 4:197–203

    Article  PubMed  CAS  Google Scholar 

  8. Derksen RH, Hene RJ, Kater L (1992) The long-term clinical outcome of 56 patients with biopsy-proven lupus nephritis followed at a single center. Lupus 1:97–103

    Article  PubMed  CAS  Google Scholar 

  9. Ravinal RC, Costa RS, Coimbra TM, Pastorello MT, Coelho EB, Dantas M, dos RM (2002) Classes, activity and chronicity indices, and alpha-smooth muscle actin expression as prognostic parameters in lupus nephritis outcome. Lupus 11:82–87

    Article  PubMed  Google Scholar 

  10. Nossent HC, Henzen-Logmans SC, Vroom TM, Berden JH, Swaak TJ (1990) Contribution of renal biopsy data in predicting outcome in lupus nephritis. Analysis of 116 patients. Arthritis Rheum 33:970–977

    Article  PubMed  CAS  Google Scholar 

  11. Chan TM, Tse KC, Tang CS, Lai KN, Li FK (2005) Long-term outcome of patients with diffuse proliferative lupus nephritis treated with prednisolone and oral cyclophosphamide followed by azathioprine. Lupus 14:265–272

    Article  PubMed  CAS  Google Scholar 

  12. Korbet SM, Lewis EJ, Schwartz MM, Reichlin M, Evans J, Rohde RD (2000) Factors predictive of outcome in severe lupus nephritis. Lupus Nephritis Collaborative Study Group. Am J Kidney Dis 35:904–914

    Article  PubMed  CAS  Google Scholar 

  13. Chen YE, Korbet SM, Katz RS, Schwartz MM, Lewis EJ (2008) Value of a complete or partial remission in severe lupus nephritis. Clin J Am Soc Nephrol 3:46–53

    Article  PubMed  CAS  Google Scholar 

  14. Golbus J, McCune WJ (1994) Lupus nephritis. Classification, prognosis, immunopathogenesis, and treatment. Rheum Dis Clin North Am 20:213–242

    PubMed  CAS  Google Scholar 

  15. Austin HA 3rd, Klippel JH, Balow JE, le Riche NG, Steinberg AD, Plotz PH, Decker JL (1986) Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs. N Engl J Med 314:614–619

    Article  PubMed  Google Scholar 

  16. Boumpas DT, Austin HA 3rd, Vaughn EM, Klippel JH, Steinberg AD, Yarboro CH, Balow JE (1992) Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet 340:741–745

    Article  PubMed  CAS  Google Scholar 

  17. Gourley MF, Austin HA 3rd, Scott D, Yarboro CH, Vaughan EM, Muir J, Boumpas DT, Klippel JH, Balow JE, Steinberg AD (1996) Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern Med 125:549–557

    PubMed  CAS  Google Scholar 

  18. Contreras G, Pardo V, Leclercq B, Lenz O, Tozman E, O'Nan P, Roth D (2004) Sequential therapies for proliferative lupus nephritis. N Engl J Med 350:971–980

    Article  PubMed  CAS  Google Scholar 

  19. Austin HA 3rd, Muenz LR, Joyce KM, Antonovych TA, Kullick ME, Klippel JH, Decker JL, Balow JE (1983) Prognostic factors in lupus nephritis. Contribution of renal histologic data. Am J Med 75:382–391

    Article  PubMed  Google Scholar 

  20. Kim YG, Kim HW, Cho YM, Oh JS, Nah SS, Lee CK, Yoo B (2008) The difference between lupus nephritis class IV-G and IV-S in Koreans: focus on the response to cyclophosphamide induction treatment. Rheumatology (Oxford) 47:311–314

    Article  CAS  Google Scholar 

  21. Mok CC, Wong RW, Lau CS (1999) Lupus nephritis in Southern Chinese patients: clinicopathologic findings and long-term outcome. Am J Kidney Dis 34:315–323

    Article  PubMed  CAS  Google Scholar 

  22. Houssiau FA, Vasconcelos C, D'Cruz D, Sebastiani GD, de Ramon GE, Danieli MG, Abramovicz D, Blockmans D, Mathieu A, Direskeneli H, Galeazzi M, Gul A, Levy Y, Petera P, Popovic R, Petrovic R, Sinico RA, Cattaneo R, Font J, Depresseux G, Cosyns JP, Cervera R (2004) Early response to immunosuppressive therapy predicts good renal outcome in lupus nephritis: lessons from long-term followup of patients in the Euro-Lupus Nephritis Trial. Arthritis Rheum 50:3934–3940

    Article  PubMed  Google Scholar 

  23. Esdaile JM, Levinton C, Federgreen W, Hayslett JP, Kashgarian M (1989) The clinical and renal biopsy predictors of long-term outcome in lupus nephritis: a study of 87 patients and review of the literature. Q J Med 72:779–833

    PubMed  CAS  Google Scholar 

  24. Faurschou M, Starklint H, Halberg P, Jacobsen S (2006) Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure. J Rheumatol 33:1563–1569

    PubMed  Google Scholar 

  25. Fiehn C, Hajjar Y, Mueller K, Waldherr R, Ho AD, Andrassy K (2003) Improved clinical outcome of lupus nephritis during the past decade: importance of early diagnosis and treatment. Ann Rheum Dis 62:435–439

    Article  PubMed  CAS  Google Scholar 

  26. Mok CC, Ho CT, Chan KW, Lau CS, Wong RW (2002) Outcome and prognostic indicators of diffuse proliferative lupus glomerulonephritis treated with sequential oral cyclophosphamide and azathioprine. Arthritis Rheum 46:1003–1013

    Article  PubMed  CAS  Google Scholar 

  27. Mok CC, Ying KY, Ng WL, Lee KW, To CH, Lau CS, Wong RW, Au TC (2006) Long-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide. Am J Med 119(355):e325–e333

    Google Scholar 

  28. Ioannidis JP, Boki KA, Katsorida ME, Drosos AA, Skopouli FN, Boletis JN, Moutsopoulos HM (2000) Remission, relapse, and re-remission of proliferative lupus nephritis treated with cyclophosphamide. Kidney Int 57:258–264

    Article  PubMed  CAS  Google Scholar 

  29. Schwartz MM, Lan SP, Bernstein J, Hill GS, Holley K, Lewis EJ (1992) Role of pathology indices in the management of severe lupus glomerulonephritis. Lupus Nephritis Collaborative Study Group. Kidney Int 42:743–748

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bin Yoo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

So, M.W., Koo, B.S., Kim, YG. et al. Predictive value of remission status after 6 months induction therapy in patients with proliferative lupus nephritis: a retrospective analysis. Clin Rheumatol 30, 1399–1405 (2011). https://doi.org/10.1007/s10067-011-1778-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-011-1778-2

Keywords

Navigation