LUPUS MEMBRANOUS NEPHROPATHY - LONG-TERM OUTCOME

The follow-up of 42 patients affected by lupus membranous nephropathy (LMN) is reported and compared with that of 43 patients affected by di ffuse proliferative lupus glomerulonephritis (DPGN), who were the obje ct of a previous study. According to the WHO classification, the patie nts were subdivided into two groups: pure LMN (Va + Vb class) and LMN with superimposed proliferative lesions (Vc + Vd class). Antiphospholi pid antibodies (APA) and lupus anticoagulant were tested in 23 subject s. All the patients were treated with corticosteroids, which were asso ciated to cytotoxic drugs in 28 cases. Although a higher number of com plete remissions was obtained in patients with pure LMN, the differenc e between the 2 groups was not significant (7/26 vs 1/16). At 10 years kidney survival was 93% in all LMN patients with no significant diffe rences between the 2 groups. This 10-year kidney survival rate is very similar to that previously observed by us for DPGN (91%). The WHO his tological classification and the chronicity index did not identify the patients who reach end-stage renal failure. Eight patients suffered f rom thrombotic manifestations which were the cause of death in two cas es. Fourteen of the 20 patients studied presented echocardiographic ab normalities. A statistically significant association was found between the occurrence of cardiovascular complications and APA levels. The ef fectiveness of treatment in LMN remains controversial. We suggest, how ever, that adequate therapy may significantly improve the prognosis of lupus nephritis thus reducing the differences in the outcome of SLE p atients having different histological WHO classes. Cardiovascular illn ess represents a frequent and severe late complication.