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Time of initial appearance of renal symptoms in the course of systemic lupus erythematosus as a prognostic factor for lupus nephritis

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Modern Rheumatology

Abstract

The prognosis of lupus nephritis (LN) was studied retrospectively in two LN categories, LN manifested initially at systemic lupus erythematosus (SLE) onset (I-LN) and LN of delayed manifestation after SLE onset (D-LN), based on a chart review (C) of 154 SLE (85 LN) patients with a mean observation of 20.8 ± 9.3 years and a questionnaire study (Q) of 125 LN patients outside our hospital with mean observation of 17.6 ± 9.2 years. In both study groups, half of I-LN patients were relapse-free by Kaplan–Meier analysis after initial therapy, and the relapsed I-LN patients responded to retherapy at higher 5-year relapse-free rates than those of patients receiving initial therapies for D-LN. At last observation, a higher frequency of prolonged remission was shown in I-LN compared with D-LN patients (C: 22/31, 71% versus 14/49, 29%, P < 0.01; Q: 65/89, 73% versus 11/33, 33% P < 0.01) and also a higher frequency of irreversible renal damage in D-LN compared with I-LN patients (C: 25/49, 51% versus 2/31, 6%, P < 0.001; Q: 14/33, 42% versus 6/89, 7%, P < 0.001), although class IV pathology was common in patients (C) in both LN categories. Onset time of lupus nephritis in the course of SLE may affect renal prognosis.

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Acknowledgments

We thank Ms. Hatazawa and other board members of the Patients’ Association of Collagen Diseases in Japan for inserting our questionnaire sheet in the journal and collecting reply mail from the patients. This work was supported by Grants-in-Aid for Research on Intractable Diseases from the Ministry of Health, Labour, and Welfare in Japan.

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Authors and Affiliations

  1. Division of Rheumatic Diseases, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Yuko Takahashi, Akitake Suzuki, Hiroyuki Yamashita, Junwa Kunimatsu, Kenji Itoh & Akio Mimori

  2. Department of Epidemiology and International Health, Research Institute, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Tetsuya Mizoue

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  1. Yuko Takahashi
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  2. Tetsuya Mizoue
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Correspondence to Akio Mimori.

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Takahashi, Y., Mizoue, T., Suzuki, A. et al. Time of initial appearance of renal symptoms in the course of systemic lupus erythematosus as a prognostic factor for lupus nephritis. Mod Rheumatol 19, 293–301 (2009). https://doi.org/10.1007/s10165-009-0154-4

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  • DOI: https://doi.org/10.1007/s10165-009-0154-4

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