Prognostic factors of diffuse proliferative lupus nephritis

Area of Science:

• Nephrology
• Immunology
• Internal Medicine

Background:

• Diffuse proliferative lupus nephritis (DPLN) represents the most severe manifestation of lupus nephritis.
• Understanding DPLN's clinical course and treatment response is critical for patient outcomes.

Purpose of the Study:

• To compare the effectiveness of intravenous cyclophosphamide pulse (CY) versus oral corticosteroid (PO) treatment modalities for DPLN.
• To identify prognostic factors influencing remission and renal survival in DPLN patients.

Main Methods:

• Retrospective analysis of 90 DPLN patients confirmed by kidney biopsy and treated for at least 12 months.
• Patients were categorized into intravenous cyclophosphamide pulse (CY) or oral corticosteroid (PO) groups.
• Prognostic factors for remission and renal survival were assessed using univariate and multivariate analyses.

Main Results:

• No significant differences in mortality, remission, or renal survival rates were observed between CY and PO groups.
• Significant differences noted in nephrotic syndrome and initial azotemia frequencies between treatment groups.
• Chronicity index (CI), male sex, and initial renal insufficiency were identified as key prognostic factors for DPLN remission and renal survival.

Conclusions:

• Chronicity index, male sex, and initial renal insufficiency are significant prognostic factors for DPLN.
• Oral corticosteroid treatment may be effective for inducing remission in DPLN patients with mild histologic and clinical features.
• Pre-treatment evaluation of prognostic factors is essential for selecting optimal DPLN treatment strategies.