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Factors affecting outcome and prognosis in membranous lupus nephropathy
Lucile Mercadal1, Sophie Tézenas du Montcel, Dominique Nochy
1Nephrology Department, Pitié Salpêtrière Hospital, Paris, France. lucile.mercadal@psl.ap-hop-paris.fr
Background:
This study was designed to review the prognosis and the predictors of renal outcome in patients with membranous lupus nephropathy (MLN) with no or mild mesangial proliferation.
Methods:
The medical records of patients (n=66) with biopsy-proven MLN, WHO class VA, and class VB without any past history of proliferative lupus nephropathy (PLN) were reviewed retrospectively.
Results:
The mean follow-up was 6.9+/-0.2 years and renal survival at 5 and 10 years was 97+/-2 and 88+/-6%. Twenty-nine patients underwent a second renal biopsy during follow-up. Fourteen of these patients (21%) had lesions of PLN. Among them, four reached end-stage renal disease (ESRD) despite immunosuppressive treatment. The probability of a transition from MLN to PLN at 10 years was 35+/-8%. Two other patients reached ESRD but did not have repeat renal biopsies and two had biopsy-proven progression to fibrosis. Independent risk factors associated with the doubling of creatinine were transition into PLN and the occurrence of a thrombosis during follow-up. The only predictor of ESRD was the haemoglobin level. PLN was not a predictor of ESRD but the efficient treatment of this form of lupus nephritis prevented that outcome.
Conclusions:
With a long follow-up, our study noted a high frequency of transition into PLN in a large cohort of patients with MLN. Steroid usage was not predictive of outcome and did not affect renal survival, a result that must be qualified in light of the highly variable duration of treatments with steroids. The early screening and treatment of PLN is the main benefit of the close follow-up of patients with MLN. Progression to ESRD with only fibrosis remains a rare event.
Insights
Patients with membranous lupus nephropathy (MLN) often transition to proliferative lupus nephropathy (PLN), highlighting the need for close monitoring. Early detection and treatment of PLN are crucial for preserving kidney function and preventing end-stage renal disease (ESRD).
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- Focuses on patients with membranous lupus nephropathy (MLN), specifically WHO class VA and VB.
- Excludes patients with a prior history of proliferative lupus nephropathy (PLN).
Purpose of the Study:
- To review the prognosis of MLN patients.
- To identify predictors of renal outcomes in MLN.
- To assess the transition rate from MLN to PLN.
Main Methods:
- Retrospective review of medical records for 66 patients with biopsy-proven MLN.
- Analysis of renal survival rates and transition to PLN.
- Evaluation of risk factors for renal outcome, including second biopsies and thrombosis.
Main Results:
- High renal survival rates at 5 (97%) and 10 years (88%).
- Significant 10-year probability of transition from MLN to PLN (35%).
- Transition to PLN and thrombosis were independent risk factors for creatinine doubling; hemoglobin level predicted ESRD.
Conclusions:
- MLN patients exhibit a high frequency of transition to PLN.
- Steroid use did not predict renal survival, potentially due to variable treatment durations.
- Close follow-up and early screening/treatment of PLN are vital for managing MLN patients.