Prognostic factors of diffuse proliferative lupus nephritis

Citation
Cs. Lim et al., Prognostic factors of diffuse proliferative lupus nephritis, CLIN NEPHR, 52(3), 1999, pp. 139-147
Citations number
37
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
CLINICAL NEPHROLOGY
ISSN journal
0301-0430 → ACNP
Volume
52
Issue
3
Year of publication
1999
Pages
139 - 147
Database
ISI
SICI code
0301-0430(199909)52:3<139:PFODPL>2.0.ZU;2-M
Abstract
Background: Diffuse proliferative lupus nephritis (DPLN) is the most severe form in lupus nephritis. Patients and methods: We retrospectively analyzed 90 DPLN patients who were confirmed by kidney biopsy and treated at least for 12 months to compare the effectiveness of treatment modalities and to i nvestigate the prognostic factors of DPLN. The patients were categorized to intravenous cyclophosphamide pulse (CY) group and oral corticosteroid (wit h/without cytotoxic drug, PO) group. Results: When the CY,group (69 patient s) and PO group (21 patients) were compared, there were no differences betw een two groups in sex, age, histologic chronicity index (CT, 4.55 vs 3.76; CY vs PO, respectively), mortality rate (4.3% vs 0%), remission rate of nep hritis (at 3-year 59.1% vs 75.5%), renal survival rate (at 5-year 88.0% vs 91.7%) and complications of treatment, but significant differences in the f requency of nephrotic syndrome (66.7% vs 33.3%) and initial azotemia (30.4% vs 0%), histologic activity index (7.14 vs 4.33) and relapse rate (2.9% vs 42.9%). When the remission group (49 patients) and non-remission group (41 patients) were compared, CI, initial renal insufficiency, male sex and the duration of nephritis were the prognostic factors for remission in univari ate analysis, and male sex (OR 10.99) and CI (OR 9.89) in multivariate anal ysis. When the remission group (35 patients) and non-remission (34 patients ) group were compared in the CY group, CI was the prognostic factor in univ ariate analysis, and CI (OR 8.63) and male sex (OR 5.54) in multivariate an alysis. The initial renal insuffciency (OR 12.74) and male sex (OR 7.99) we re the prognostic factors for renal survival. The renal survival rate was 1 00% in remission-induced patients. Conclusion: We conclude that CI, male se x, initial renal insufficiency were the prognostic factors of DPLN, and tre atment with oral corticosteroid could induce remission in patients who had mild histologic and clinical features. Therefore it would be necessary to e valuate the prognostic factors before the selection of treatment modality.