Lupus nephritis in southern Chinese patients: Clinicopathologic findings and long-term outcome

Despite the improvement in survival of patients with systemic lupus erythem atosus (SLE) and associated nephritis in the past 20 years, few studies of the long-term outcome of large cohorts of patients with well-defined histol ogical classes of lupus nephropathy are available. We examined the long-ter m outcome of 183 patients with lupus nephritis (LN) followed up by the Divi sion of Rheumatology at Queen Mary Hospital (Hong Kong) between 1976 and 19 97, Their renal biopsies were classified according to World Health Organiza tion (WHO) criteria. There were 27 men and 156 women. Initial renal biopsy showed the following WHO classes of LN: 2 patients (1%), class 1; 9 patient s (5%), class II; 46 patients (25%), class III; 101 patients(55%), class IV ; and 25 patients (14%), class V. The mean duration of follow-up from the r enal biopsy was 130.7 +/- 5.9 months (range, 13 to 260 months), The overall 5-, 10-, and 15-year survival and renal survival (survival without dialysi s) rates were 98.9%, 94.4%, and 94.4% and 92.1%, 81.2%, and 75.2%, respecti vely, Univariate analysis showed class IV nephritis, hypertension, impaired renal function (glomerular filtration rate < 50 mL/min), nephrotic syndrom e at time of renal biopsy, and failure of complete remission in the first y ear of treatment were unfavorable predictors for renal survival. Multivaria te analysis using the Cox regression model also showed persistent hypertens ion, class IV nephritis, and incomplete renal remission in the first year w ere independent risk factors for renal failure. Our results showed the rena l survival rate of our patients from South China with LN was similar to tha t of most reported series of white patients. Prospective randomized studies with well-defined treatment protocols are needed to delineate the optimal treatment strategy for LN, (C) 1999 by the National Kidney Foundation, Inc.