Outcome of Lupus nephritis-A 5-year Analysis

Abstract

Objective: To investigate the long-term outcome of class IV lupus nephritis (LN) and to analyze its prognostic factors. Materials and Methods: We performed a retrospective chart review study of 157 patients with LN between January 1986 and June 2004 in Chang Gung Memorial Hospital at Kaohsiung. All of these LN patients fulfilled the systemic lupus erythematosus classification criteria of the American College of Rheumatology and had histopathological findings of LN. Only those pathology-proved subjects with class IV by 2003 ISN/RPS classification were recruited. We reviewed the charts and collected the demographic data, serological parameters, and treatment courses of subjects recruited. The end point of renal outcome were doubling of serum creatinine (I) and end stage renal disease (ESRD)/death (II) within 60 months after renal biopsy Results: A total of 75 subjects were recruited, including 13 male and 62 female. Mean age was 25.9±9.7 year. Five years after renal biopsy, 16 subjects (21.3%) developed outcome I and 15 subjects (20.0%) developed outcome II. Those who did not develop outcome I had higher mean (14.5±2.1) activity index (AI) than that (13.1±2.5) of those did (HR=0.55, CI=0.35-0.87, p=0.01). For those who did not develop outcome II, the mean AI was also higher than those who did (14.4±2.2 vs.13.5±2.3, HR=0.67, CI=0.44-1.00, p=0.05). Conclusions: The 5-year renal survival of current series, in terms of ESRD/death, was 80% and this was not as favorable as those reported in the other investigations. High activity index at biopsy is a predictor of favorable prognosis of long-term renal outcomes in case that aggressive treatment had been given.