THE PROGNOSIS OF BIOPSY-PROVEN LUPUS NEPHRITIS IN CHINESE PATIENTS - LONG-TERM FOLLOW-UP OF 86 CASES

Objective To investigate the prognosis of lupus nephritis (LN) and its influencing factors in patients with lupus nephritis in China. Method s A retrospective study was carried out in 86 patients followed up for at least 5 years. Clinical features, serological and immunological te sts were investigated. Renal biopsies were performed at the beginning of the study and repeated in some cases during the follow-up period. A ll the 86 patients had serum creatinine (Sfr) level less than 132. 6 m u mol/L at the inital presentation and were divided into three groups according: to the level of Scr at the end of the study. Group I : the patients with normal renal function (Scr<132. 6 mu mol/L); Group II : the patients with mild similar to moderate renal insufficiency (132. 6 mu mol/L) Scr less than or equal to 530. 4 mu mol/L); Group III : the patients with end stage real failure (ESRF) (Scr greater than or equa l to 530. 4 mu mol/L), Results Forty-seven patients reached clinical r emission with normal renal function, 11 had with stabilization of rena l function although the systemic lupus erythematosis (SLE) activity re lapsed repeatedly, while 28 subjects developed renal insufficiency aft er 60 similar to 170 (mean 88. 12 +/- 28. 23) months of observation. E SRF rate was 11. 6% in this group of patients. Eight patients died (2 died of infections and 6 died of ESRF) during the follow-up period. At the beginning of the study the rates of hypertension, persistent anem ia and hematuria in Group III were 50%, 70% and 70% respectively, bein g much higher than those in Group I. The calculation of AI and CI in 6 0 patients revealed that there were 65% of patients with AI greater th an or equal to 7 and 70% of patients with CI greater than or equal to 3 in Groups II and III, while in Group I there were only 32% of patien ts with AI greater than or equal to 7 and 19% of patients with CI grea ter than or equal to 3. Sixteen cases had pathologic class changed in 48 repeated biopsies. Seven cases changed to Class IV, 5 to Class II, 3 to Class V from other classes and one to class III from Class II. Co nclusions Factors associated with the development of renal insufficien cy in these lupus patients included hypertension, anemia and hematuria . Renal biopsy evaluation offered additional prognostic information an d showed that patients with severe active and chronic histologic chang es were at risk for developing renal isufficiency. During the clinical course, the renal classification of LN changed in certain patients, t hus the histologic classification of renal morphology at initial prese ntation did not fully predict the outcome.