Skip to main content

Advertisement

SpringerLink
Log in

Investigation of pathological and clinical features of lupus nephritis in 73 autopsied cases with systemic lupus erythematosus

  • Original Article
  • Published:
Modern Rheumatology

Abstract

The aims of this study were to analyze the clinical and pathological features of lupus nephritis (LN) and examine the association between these features and pathological condition, treatment, and prognosis. Of the 177 systemic lupus erythematosus patients who died while receiving inpatient care at Juntendo University Hospital between 1960 and 2001, we investigated the clinical features, treatment, and pathological features of 73 of these who underwent pathological autopsy and had a clear medical history. We divided these cases into two groups, i.e., those up to 1979 (Group A) and those during and after 1980 (Group B) in order to investigate changes in tendencies by age. We also divided the cases into three groups by time interval between diagnosis and death to investigate long-term prognosis. Uremia was the direct cause of death in 38.9% of cases in Group A and only 10.8% of cases in Group B. Pathological features showed a tendency to change to a sclerotic lesion as the duration of the disorder became longer. Uremia attributable to LN was the direct cause of death in relatively fewer cases, although it is still found in the majority of LN cases and remains a problem requiring stringent management. The treatment of sclerotic lesions may be an issue that needs further attention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Arao T, Fujiki T, Kosumi H, Hatono C, Numata T. 4 autopsy cases of systemic lupus erythematosus, especially on lupus nephritis. Nippon Hifuka Gakkai Zasshi. 1961;71:524–33.

    CAS  PubMed  Google Scholar 

  2. Grishman E, Gerber MA, Churg J. Patterns of renal injury in systemic lupus erythematosus: light and immunofluorescence microscopic observations. Am J Kidney Dis. 1982;2[Suppl 1]:135–41.

    CAS  PubMed  Google Scholar 

  3. Grishman E, Venkataseshan VS. Vascular lesions in lupus nephritis. Mod Pathol. 1988;1(3):235–41.

    CAS  PubMed  Google Scholar 

  4. Tan Eng M, Cohen Alan S, Fries James F, Masi Alfonse T, McShane Dennis J, Rothfield Naomi F, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982;25:1271–7.

    Article  CAS  PubMed  Google Scholar 

  5. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.

    Article  CAS  PubMed  Google Scholar 

  6. Austin HA 3rd, Muenz LR, Joyce KM, Antonovych TT, Balow JE. Diffuse proliferative lupus nephritis: identification of specific pathologic features affecting renal outcome. Kidney Int. 1984;25:689–95.

    Article  PubMed  Google Scholar 

  7. Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int. 2004;65:521–30.

    Article  PubMed  Google Scholar 

  8. Churg J, Sobin LH. Renal disease: classification and atlas of glomerular disease. Tokyo: Igaku-Shoin; 1982. p. 127–31.

    Google Scholar 

  9. Churg J, Bernstein J, Glassok RJ. Renal disease: classification and atlas of glomerular disease. 2nd ed. New York: Igaku-Shoin; 1995. p. 151–6.

    Google Scholar 

  10. Merrel M, Shulman LE. Determination of prognosis in chronic disease, illustrated by systemic lupus erythematosus. J Chronic Dis. 1955;1:12–32.

    Article  Google Scholar 

  11. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestation in a cohort of 1000 patients. Medicine. 2003;82:299–308.

    Article  PubMed  Google Scholar 

  12. Mok CC, Lee KW, Ho CT, Lau CS, Wong RW. A prospective study of survival and prognostic indicators of systemic lupus erythematosus in a southern Chinese population. Rheumatology (Oxford). 2000;39:399–406.

    Article  CAS  Google Scholar 

  13. Mok CC, Wong RW, Lau CS. Lupus nephritis in southern Chinese patients: clinicopathologic findings and long-term outcome. Am J Kidney Dis. 1999;34:315–23.

    Article  CAS  PubMed  Google Scholar 

  14. Bono L, Cameron JS, Hicks JA. The very long-term prognosis and complications of lupus nephritis and its treatment. QJM. 1999;92:211–8.

    Article  CAS  PubMed  Google Scholar 

  15. Mok CC, Mak A, Chu WP, To CH, Wong SN. Long-term survival of southern Chinese patients with systemic lupus erythematosus. Medicine. 2005;84:218–24.

    Article  PubMed  Google Scholar 

  16. Kang I, Park SH. Infectious complications in SLE after immunosuppressive therapies. Curr Opin Rheumatol. 2003;15:528–34.

    Article  CAS  PubMed  Google Scholar 

  17. Fiehn C, Hajiar Y, Mueller K, Waldherr R, Ho AD, Andrassy K. Improved clinical outcome of lupus nephritis during the past decade: importance of early diagnosis and treatment. Ann Rheum Dis. 2003;62:435–9.

    Article  CAS  PubMed  Google Scholar 

  18. Nagasawa T. Collagen disease and dialysis—overview. Jpn J Clin Dial. 1995;11:917–22.

    Google Scholar 

  19. Doria A, Iaccarino L, Ghirardello A, Zampieri S, Arienti S, Sarzi-Puttini P, et al. Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med. 2006;119:1497–9.

    Article  Google Scholar 

  20. Bernatsky S, Clarke A, Ramsey-Goldman R. Malignancy and systemic lupus erythematosus. Curr Rheumatol Rep. 2002;4:351–8.

    Article  PubMed  Google Scholar 

  21. Abu-Shakra M, Ehrenfeld M, Shoenfeld Y. Systemic lupus erythematosus and cancer: associated or not? Lupus. 2002;11:137–44.

    Article  CAS  PubMed  Google Scholar 

  22. Najafi CC, Korbet SM, Lewis EJ, Schwartz MM, Reichlin M, Evans J. Significance of histologic patterns of glomerular injury upon long-term prognosis in severe lupus glomerulonephritis. Kidney Int. 2001;59:2156–63.

    CAS  PubMed  Google Scholar 

  23. Contreras G, Lenz O, Pardo V, Borja E, Cely C, Iqbal K, et al. Outcomes in African American s and Hispanics with lupus nephritis. Kidney Int. 2006;69:1846–51.

    Article  CAS  PubMed  Google Scholar 

  24. Terai C, Koseki Y, Uesato M, Moriguchi M. Lupus nephritis. Intern Med. 1999;83:78–81.

    Google Scholar 

  25. Gonzalez-Crespo MR, Lopez-Fernandez JI, Usera G, Poveda MJ, Gomez-Reino JJ. Outcome of silent lupus nephritis. Semin Arthritis Rheum. 1996;26:468–76.

    Article  CAS  PubMed  Google Scholar 

  26. Zabaleta-Lanz M, Vargas-Arenas RE, Tapanes F, Daboin I, Atahualpa Pinto J, Bianco NE. Silent nephritis in systemic lupus erythematosus. Lupus. 2003;12:26–30.

    Article  CAS  PubMed  Google Scholar 

  27. Valeri A, Radhakrishnan J, Estes D, D’Agati V, Kopelman R, Pernis A, et al. Intravenous pulse cyclophosphamide treatment of severe lupus nephritis: a prospective five-year study. Clin Nephrol. 1994;42:71–8.

    CAS  PubMed  Google Scholar 

  28. Kunis CL, Kiss B, Williams G, et al. Intravenous “pulse” cyclophosphamide therapy of crescentic glomerulonephritis. Clin Nephrol. 1992;37(1):1–7.

    CAS  PubMed  Google Scholar 

  29. Tse KC, Li FK, Tang CS, Lai KN, Chan TM. Angiotensin inhibition or blockade for the treatment of patients with quiescent lupus nephritis and persistent proteinurea. Lupus. 2005;14:947–52.

    Article  CAS  PubMed  Google Scholar 

  30. Honma M, Ichikawa Y, Akizuki M, Kashiwazaki S, Kondo H, Hashimoto H, et al. Double blind trial of pulse methylprednisolone versus conventional oral prednisolone in lupus nephritis. Ryumachi. 1994;34(3):616–27.

    CAS  PubMed  Google Scholar 

  31. Gourley MF, Austin HA 3rd, Scott D, Yarboro CH, Vaughan EM, Muir J, et al. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled tiral. Ann Intern Med. 1996;125(7):549–57.

    CAS  PubMed  Google Scholar 

  32. Sesso R, Monteiro M, Sato E, Kirsztajn G, Silva L, Ajzen H. A controlled trial of pulse cyclophosphamide versus pulse methylprednisolone in severe lupus nephritis. Lupus. 1994;3(2):107–12.

    Article  CAS  PubMed  Google Scholar 

  33. Radharkrishnan J, Kunis CL, D’Agati V, Appel GB. Cyclosporin treatment of lupus membranous nephropathy. Clin Nephrol. 1994;42:147–54.

    Google Scholar 

  34. Rihova Z, Vankova Z, Maixnerova D, Dostal C, Jancova E, Honsova E, et al. Treatment of lupus nephritis with cyclosporine—an outcome analysis. Kidney Blood Press Res. 2007;30(2):124–8.

    Article  CAS  PubMed  Google Scholar 

  35. Jonsdottir T, Gunnarsson I, Risselada A, Henriksson EW, Klareskog L, van Vollenhoven RF. Treatment of refractory SLE with rituximab plus cyclophosphamide: clinical effects, serological changes, and predictors of response. Ann Rheum Dis. 2008;67(3):330–4.

    Article  CAS  PubMed  Google Scholar 

  36. Mok CC, Tong KH, To CH, Siu YP, Au TC. Tacrolimus for induction therapy of diffuse proliferative lupus nephritis: an open-labeled pilot study. Kidney Int. 2005;68:813–7.

    Article  CAS  PubMed  Google Scholar 

  37. Cordeiro AC, Isenberg DA. Novel therapies in lupus—focus on nephritis. Acta Reumatol Port. 2008;33(2):157–69.

    PubMed  Google Scholar 

  38. Abu-Shakra M, Urowitz MB, Gladman DD, Gough J. Mortality studies in systemic lupus erythematosus. Results from a single center. I. Causes of death. J Rheumatol. 1995;22:1259–64.

    CAS  PubMed  Google Scholar 

  39. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestation in a cohort of 1000 patients. Medicine (Baltimore). 2003;82:299–308.

    Article  Google Scholar 

  40. Doria A, Iaccarino L, Ghirardello A, Zampieri S, Arienti S, Sarzi-Puttini P, et al. Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med. 2006;119:700–6.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, 11th Floor, 9th Building, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan

    Takayuki Kon, Ken Yamaji, Kaoru Sugimoto, Michihiro Ogasawara, Kazuo Kenpe, Hitoshi Ogasawara, Hiroshi Hashimoto & Yoshinari Takasaki

  2. Geriatric General Medicine, Juntendo Tokyo Kotoh Geriatric Medical Center, Tokyo, Japan

    Kwang-Seok Yang & Hiroshi Tsuda

  3. Department of Pathology (I), Juntendo University School of Medicine, Tokyo, Japan

    Toshiharu Matsumoto

Authors
  1. Takayuki Kon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ken Yamaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kaoru Sugimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michihiro Ogasawara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuo Kenpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hitoshi Ogasawara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kwang-Seok Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroshi Tsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toshiharu Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroshi Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshinari Takasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takayuki Kon.

About this article

Cite this article

Kon, T., Yamaji, K., Sugimoto, K. et al. Investigation of pathological and clinical features of lupus nephritis in 73 autopsied cases with systemic lupus erythematosus. Mod Rheumatol 20, 168–177 (2010). https://doi.org/10.1007/s10165-009-0260-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10165-009-0260-3

Keywords

Search

Navigation