CLINICAL-SIGNIFICANCE OF NECROSIS IN LUPUS NEPHRITIS

The significance of necrosis (karyorrhexis), among the most characteri stic findings in lupus nephritis, was evaluated by studying the correl ation between the existence of necrosis in renal biopsy specimens and laboratory findings. The subjects were 54 patients with diffuse prolif erative lupus nephritis and 6 patients with focal proliferative lupus nephritis selected from 143 patients with lupus nephritis. We also com pared the clinical course of oral prednisolone and intravenous methylp rednisolone pulse therapies after steroid administration. Compared wit h the non-necrosis group, the necrosis group had significantly lower C H50 levels and more proteinuria. Patients with necrosis were effective ly treated with repeated pulse therapy judging by immunological activi ty and the decrease in proteinuria at an early stage, but responded po orly to oral steroid therapy. As the presence of necrosis in cases of lupus nephritis means high immunological activity of the lesion and th ere is responsiveness to a large dose of steroids, extensive immunosup pressive therapy including methylprednisolone pulse therapy should be applied to these patients.