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Lupus membranous nephropathy: long-term outcome
S Pasquali1, G Banfi, A Zucchelli
1Department of Nephrology and Dialysis, Malpighi Hospital Bologna, Italy.
Clinical Nephrology
|April 1, 1993
Summary
Lupus membranous nephropathy (LMN) patients show high kidney survival rates, similar to diffuse proliferative lupus glomerulonephritis (DPGN). Cardiovascular complications are frequent in LMN, linked to antiphospholipid antibodies.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Lupus membranous nephropathy (LMN) is a significant cause of kidney damage in Systemic Lupus Erythematosus (SLE).
- Understanding the long-term outcomes and complications of LMN is crucial for patient management.
- Comparison with other lupus nephritis classes, like diffuse proliferative lupus glomerulonephritis (DPGN), aids in prognostic evaluation.
Purpose of the Study:
- To report the follow-up of patients with lupus membranous nephropathy (LMN).
- To compare outcomes of LMN with a previously studied cohort of diffuse proliferative lupus glomerulonephritis (DPGN).
- To investigate the association between histological classification, antiphospholipid antibodies (APA), and clinical outcomes in LMN.
Main Methods:
- Follow-up of 42 patients with LMN, classified by WHO criteria into pure LMN (classes Va+Vb) and LMN with superimposed proliferative lesions (classes Vc+Vd).
- Comparison with 43 DPGN patients from a prior study.
- Testing for antiphospholipid antibodies (APA) and lupus anticoagulant in 23 subjects.
- Treatment involved corticosteroids, with cytotoxic drugs added in 28 cases.
- Assessment of kidney survival, remission rates, thrombotic events, and echocardiographic abnormalities.
Main Results:
- Kidney survival at 10 years was 93% for all LMN patients, comparable to DPGN (91%).
- Complete remission rates were higher in pure LMN but not statistically significant (7/26 vs 1/16).
- Eight patients experienced thrombotic events, causing two deaths.
- Fourteen of 20 studied patients had echocardiographic abnormalities, with a significant association between cardiovascular complications and APA levels.
Conclusions:
- LMN demonstrates a favorable long-term kidney survival rate, similar to DPGN.
- Cardiovascular complications are frequent and severe in LMN, particularly in patients with positive antiphospholipid antibodies.
- While treatment effectiveness remains debated, adequate therapy may improve lupus nephritis prognosis and reduce outcome disparities among WHO histological classes.