Clinical Rheumatology

, Volume 30, Issue 11, pp 1399–1405 | Cite as

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

  • Min Wook So
  • Bon San Koo
  • Yong-Gil Kim
  • Chang-Keun Lee
  • Bin Yoo
Original Article

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.

Keywords

Induction Lupus nephritis Remission Systemic lupus erythematosus 

References

  1. 1.
    Cameron JS (1999) Lupus nephritis. J Am Soc Nephrol 10:413–424PubMedGoogle Scholar
  2. 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 57:114–119PubMedGoogle Scholar
  3. 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) 41:981–987CrossRefGoogle Scholar
  4. 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 83:877–885PubMedCrossRefGoogle Scholar
  5. 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 45:544–550PubMedCrossRefGoogle Scholar
  6. 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 14:890–895PubMedCrossRefGoogle Scholar
  7. 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 4:197–203PubMedCrossRefGoogle Scholar
  8. 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 1:97–103PubMedCrossRefGoogle Scholar
  9. 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 11:82–87PubMedCrossRefGoogle Scholar
  10. 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 33:970–977PubMedCrossRefGoogle Scholar
  11. 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 14:265–272PubMedCrossRefGoogle Scholar
  12. 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 35:904–914PubMedCrossRefGoogle Scholar
  13. 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 3:46–53PubMedCrossRefGoogle Scholar
  14. 14.
    Golbus J, McCune WJ (1994) Lupus nephritis. Classification, prognosis, immunopathogenesis, and treatment. Rheum Dis Clin North Am 20:213–242PubMedGoogle Scholar
  15. 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 314:614–619PubMedCrossRefGoogle Scholar
  16. 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 340:741–745PubMedCrossRefGoogle Scholar
  17. 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 125:549–557PubMedGoogle Scholar
  18. 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 350:971–980PubMedCrossRefGoogle Scholar
  19. 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 75:382–391PubMedCrossRefGoogle Scholar
  20. 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) 47:311–314CrossRefGoogle Scholar
  21. 21.
    Mok CC, Wong RW, Lau CS (1999) Lupus nephritis in Southern Chinese patients: clinicopathologic findings and long-term outcome. Am J Kidney Dis 34:315–323PubMedCrossRefGoogle Scholar
  22. 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 50:3934–3940PubMedCrossRefGoogle Scholar
  23. 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 72:779–833PubMedGoogle Scholar
  24. 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 33:1563–1569PubMedGoogle Scholar
  25. 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 62:435–439PubMedCrossRefGoogle Scholar
  26. 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 46:1003–1013PubMedCrossRefGoogle Scholar
  27. 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–e333Google Scholar
  28. 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 57:258–264PubMedCrossRefGoogle Scholar
  29. 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 42:743–748PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2011

Authors and Affiliations

  • Min Wook So
    • 1
  • Bon San Koo
    • 1
  • Yong-Gil Kim
    • 1
  • Chang-Keun Lee
    • 1
  • Bin Yoo
    • 1
  1. 1.Division of Rheumatology, Department of Internal MedicineUniversity of Ulsan College of MedicineSeoulSouth Korea

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