LONG-TERM OUTCOME IN SYSTEMIC LUPUS-ERYTHEMATOSUS MEMBRANOUS GLOMERULONEPHRITIS

The pathology of membranous glomerulonephritis (MGN) in patients with systemic lupus erythematosus (SLE) may be complicated by superimposed glomerular inflammation and/or necrosis, This retrospective study exam ined whether various histologic patterns of glomerulonephritis (GN) se en on renal biopsy impact upon the prognosis of these patients. Clinic al parameters at the time of biopsy were also studied, to determine wh ich might serve as risk factors associated with renal and patient outc ome. On the basis of renal biopsy findings, patients were stratified i nto three pathological study groups by using the World Health Organiza tion (WHO) classification (11). Thirty-six patients had ''pure'' SLE M GN without (WHO Va) or with (WHO Vb) mesangial hypercellularity. Fifte en patients had SLE MGN with segmental endocapillary proliferation and /or necrosis in < 50% of glomeruli (WHO Vc < 50%). Twenty-eight patien ts had SLE MGN with endocapillary proliferation and/or necrosis in gre ater than or equal to 50% of glomeruli (MGN with segmental proliferati on and/or necrosis in > 50%, WHO Vc greater than or equal to 50%, or M GN with superimposed diffuse endocapillary proliferation, WHO Vd), The re were no significant differences in sex, age, or race among patients in the three study groups. There was a trend for increasing serum cre atinine concentration, urine protein excretion, and diastolic blood pr essure, and decreasing the third component of serum complement (C3) to be associated with increasing glomerular inflammation, and these diff erences were significant when Vc greater than or equal to 50% and Vd w as compared with Va and Vb (P < 0.05). The 5- and 10-yr actuarial surv ival rates without reaching the study outcomes of death or renal repla cement therapy for the three study groups were 86, 72, and 49% and 72, 48, and 20% respectively, and the differences between Va and Vb and V c > 50% and Vd were significant (P < 0.05), SLE MGN has a heterogeneou s course and outcome, and this variability is related to the extent an d degree of glomerulonephritis seen on renal biopsy. The only clinical factor with an independent risk of reaching a study outcome was eleva tion of the initial serum creatinine concentration (Cox regression ana lysis). This predictive value appears to apply only to patients with t he most severe forms of glomerulonephritis, suggesting that they may h ave a different natural history and/or a response to therapy than SLE MGN with less widespread glomerular inflammation and/or necrosis.