Factors predictive of outcome in severe lupus nephritis

In 1992, we published the results of a prospective, controlled trial of agg ressive therapy (high-dose prednisone plus oral cyclophosphamide alone or w ith plasmapheresis) in 86 patients with severe lupus nephritis, During this study, remission (serum creatinine less than or equal to 1.4 mg/dL [less t han or equal to 123 mu mol/L] and proteinuria less than or equal to 330 mg/ d of protein) in renal disease occurred in 37 patients (43%). To assess the long-term effect of remission on patient and renal survival, we now report the results of our extended follow-up of these patients. After an average of 10 years of follow-up in the 86 patients, patient survival rates at both 5 and 10 years were 95% in the group that had a remission and 69% at 5 yea rs and 60% at 10 years in the no-remission group (P < 0.001). Renal surviva l rates were 94% at both 5 and 10 years in the remission group compared wit h 46% at 5 years and 31% at 10 years in the no-remission group (P < 0.0001) . Features predictive of remission included stable renal function after 4 w eeks on therapy, category IV lesion, lower chronicity index, white race, lo wer urine protein excretion level at baseline, and lower baseline serum cre atinine level. The features predictive of end-stage renal disease were high er baseline serum creatinine level, presence of anti-Re antibodies, and fai lure to attain a remission. Thus, in patients with the most severe forms of lupus nephritis, a remission of clinical renal abnormalities is associated with dramatic improvement in long-term patient and renal survival. (C) 200 0 by the National Kidney Foundation, Inc.