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Long-term prognosis of diffuse lupus nephritis
C Ponticelli1, P Zucchelli, G Moroni
1Division of Nephrology and Dialysis, Hospital Maggiore Policlinico, Milano, Italy.
Insights
Long-term outcomes for diffuse proliferative lupus nephritis have improved significantly. Treatment with high-dose methylprednisolone pulses followed by steroids and cytotoxic drugs enhances kidney survival and reduces flare-ups.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Diffuse proliferative lupus nephritis (DPLN) is a severe manifestation of systemic lupus erythematosus.
- Long-term prognosis and optimal treatment strategies for DPLN remain critical areas of research.
Purpose of the Study:
- To evaluate the long-term outcomes of patients with DPLN treated with a specific regimen.
- To assess patient and kidney survival rates, renal function, and treatment-related side effects.
Main Methods:
- Follow-up of 43 patients diagnosed with DPLN.
- Treatment protocol included high-dose intravenous methylprednisolone pulses, followed by low-dose oral steroids.
- 31 patients also received cytotoxic drugs; exacerbations were treated with high-dose steroids.
Main Results:
- At 10 years, patient survival was 87% and kidney survival was 79% (91% excluding extra-renal deaths).
- Most patients maintained or recovered renal function; only 1 required regular dialysis.
- Low incidence of flare-ups (0.1 episodes/year) and rare severe side effects were observed.
Conclusions:
- The long-term prognosis for DPLN is improving considerably.
- A treatment approach using pulsed high-dose methylprednisolone and maintenance therapy with steroids and cytotoxic agents preserves renal function effectively.
- This regimen helps avoid severe side effects, contributing to better patient outcomes.
Abstract:
The follow-up of 43 patients with diffuse proliferative lupus nephritis is reported. After histological diagnosis, all patients were treated with 3 intravenous high-dose methylprednisolone pulses and then with low-dose oral steroids and 31 with cytotoxic drugs. Renal and extra-renal exacerbations were also treated with intravenous high-dose steroids. Patients were followed for 1 to 13 years. At 10 years the patient survival rate was 87% and the kidney survival rate was 79%. If 3 extra-renal deaths are excluded, the actuarial 10-year kidney survival rate is 91%. At present, 21 patients do not show any renal abnormalities, 13 patients have normal plasma creatinine but proteinuria, 3 patients have stable renal function impairment, 2 patients have worsening of their renal function, 1 is on regular dialysis. The other 3 patients died (from cardiac failure, cerebral hemorrhage and a car accident). The incidence of flare-ups was low (0.1 episodes per year). Severe side effects were rare in this series. It is concluded that the long-term prognosis of diffuse lupus nephritis is becoming considerably better. Therapy based on a short course of intravenous high-dose methylprednisolone and on a maintenance regimen with low doses of steroid and cytotoxic agents can contribute to preserving renal function while avoiding severe side effects.