Significance of histologic patterns of glomerular injury upon long-term prognosis in severe lupus glomerulonephritis

Background. Patients with systemic lupus erythematosus have a spectrum of g lomerular disease, but the different patterns of glomerular injury identifi ed within the general category of "severe" lupus glomerulonephritis are res ponsible for much of the morbidity and mortality in this disease. The glome rular injury patterns seen with severe lupus glomerulonephritis have been s eparated into distinct histopathologic groups to determine whether they can predict long-term patient outcome. Methods. We analyzed the clinical follow-up of 85 patients participating in a controlled prospective therapeutic trial for the treatment of severe lup us glomerulonephritis conducted from April 1981 to December 1988, with an a verage followup of 10 years. Patients were classified according to the 1982 World Health Organization classification for lupus glomerulonephritis. Results. During the course of follow-up [120 +/- 65 (SD) months], 60%, of p atients with category IV (diffuse proliferative glomerulonephritis) lesions entered a remission compared with only 38% of patients with category III ( greater than or equal to 50%, focal and segmental glomerulonephritis) lesio ns and 27% of patients with category Ve (greater than or equal to 50%) and Vd (P < 0.05). Renal survival at 10 years was 75% for those with category I V lesions, 47% for patients with category Vc (<greater than or equal to>50% ) and Vd. and 52% for patients with category III (greater than or equal to 50%) lesions (P < 0.05). Based on multivariate analysis, patients with cate gory III (<greater than or equal to>50%) or Vc (greater than or equal to 50 %) and Vd lesions had a relative risk of progression to end-stage renal dis ease 2.9 times that of category IV patients (P < 0.01). while the likelihoo d of entering a remission was 8.2 times greater for category IV patients (P = 0.0001). Conclusion. The histopathologic categorization among patients with severe l upus glomerulonephritis provides information relevant to their long-term ou tcome.