Prognostic factors of diffuse proliferative lupus nephritis

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 investigate the prognostic factors of DPLN. The patients were categorized to intravenous cyclophosphamide pulse (CY) group and oral corticosteroid (with/without cytotoxic drug, PO) group.

Results: When the CY group (69 patients) and PO group (21 patients) were compared, there were no differences between two groups in sex, age, histologic chronicity index (CI, 4.55 vs 3.76; CY vs PO, respectively), mortality rate (4.3% vs 0%), remission rate of nephritis (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 frequency 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 univariate analysis, and male sex (OR 10.99) and CI (OR 9.89) in multivariate analysis. When the remission group (35 patients) and non-remission (34 patients) group were compared in the CY group, CI was the prognostic factor in univariate analysis, and CI (OR 8.63) and male sex (OR 5.54) in multivariate analysis. The initial renal insufficiency (OR 12.74) and male sex (OR 7.99) were the prognostic factors for renal survival. The renal survival rate was 100% in remission-induced patients.

Conclusion: We conclude that CI, male sex, initial renal insufficiency were the prognostic factors of DPLN, and treatment with oral corticosteroid could induce remission in patients who had mild histologic and clinical features. Therefore it would be necessary to evaluate the prognostic factors before the selection of treatment modality.