Long term outcomes in severe lupus nephritis

Abstract

           Lupus nephritis is one of the most common forms of glomerulonephritis, particularly in Oriental region. Proliferative lupus nephritis is associated with poor long-term outcomes. However, natural course of crescentic lupusnephritis is not well understood. Objective: To determine clinical course associated with patients with crescentic lupus nephritis (glomerular crescents > 30%) compared with proliferative lupus nephritis with crescent <30%, including clinical presentations, remission rate, treatment modalities, renal function, and renal and patient survival. Methods: Pathologic reports and allmedical records of patients with proliferative lupus nephritis were retrospectively reviewed for clinicalpresentations,laboratory reports at the biopsy time, 6 months and 12 months after treatment, modality of treatment and treatmentoutcomes. Patients were divided into 2 groups based on percentage of glomerular crescents in pathological reports: group 1 with glomerular crescents < 30% and group 2 with crescent >30%. Results: 89 patients diagnosed during 1999-2003 were included in this study, 52 patients in group 1 and 37 patients in group 2. Patients with crescents >30% were associated more nephritis feature (91.9% vs 69.2%, P < 0.05), higher serum creatinine levels (292.5±203.9 vs 177.32±168.4 Pmol/L, P < 0.01), and lower C3 levels (523.3±212.0 vs 653.8±298.4 Pg/ml, P < 0.05). There were no differences in age, sex, SBP, DBP, duration of disease, serum albumin, cholesterol, C4, CH50, and urine protein.In group 2 received double intravenous pulse (IVMP+IVCY) therapy higher than group 1 (32.4% vs 11.5%, P < 0.05). Both groups had same maintenance therapies. Patients with more crescentic lupus nephritis were associated with poorer outcome, including initial remission rate (48.6% vs 80.7%, P < 0.01), time to doubling serum creatinine (53.8 vs 34.3 months, P < 0.05), and one renal survival (91% vs 84% P < 0.05). There were 2 patient deaths, one in each group during the study period. There was no difference in relapse rates in both groups. Conclusion: Patients with crescentic lupus nephritis > 30% were associated with more nephritic feature, higher serum creatinine levels, lower C3 levels, and poorer treatment outcomes, regarding remission rate, time to doublingserum creatinine, and renal survival.