Membranous Nephropathy in Systemic Lupus Erythematosus: Long-Term Outcome and Prognostic Factors of 103 Patients

• Published in: Seminars in arthritis and rheumatism 2012-04, Vol.41 (5), p.642-651
• Main Authors: Moroni, Gabriella, MD, Quaglini, Silvana, PhD, Gravellone, Luciana, MD, Gallelli, Beniamina, MD, Leoni, Antonio, MD, Messa, Piergiorgio, MD, Sinico, Renato Alberto, MD
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Biopsy; Creatinine - blood; Diseases of the osteoarticular system; Female; Glomerulonephritis; Glomerulonephritis, Membranous - diagnosis; Glomerulonephritis, Membranous - drug therapy; Glomerulonephritis, Membranous - physiopathology; Glucocorticoids - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - physiopathology; lupus nephritis; Male; Medical sciences; membranous nephropathy; Methylprednisolone - therapeutic use; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; patient survival; Prognosis; proliferative glomerulonephritis; Remission Induction; renal survival; Retrospective Studies; Rheumatology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Survival Rate; Treatment Outcome
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2011.08.002

Objectives The objective of this study was to evaluate the clinical features, course, outcome, and prognostic indicators in lupus membranous nephritis (LMN) and to compare data of “pure” LMN vs “mixed” forms. Methods We retrospectively examined medical records and kidney biopsies of 103 patients with a diagnosis of LMN. Results Sixty-seven patients had “pure” LMN and 36 had “mixed” forms. Patients with mixed LMN had more frequent nephrotic syndrome (66.6 vs 44.7%, P = 0.05), low C3 (83.3 vs 62.6%, P = 0.05) and C4 (80.5 vs 52.2%, P = 0.005), anti-DNA positivity (86.0 vs 62.6%, P = 0.03), and a tendency toward a lower creatinine clearance (93 ± 29 vs 112 ± 50 mL/min, P = 0.07). Moreover, mixed membranous nephritis had a higher activity and chronicity index (6.5 ± 2.1 vs 1.4 ± 2.03, P = 0.005 and 2.4 ± 1.7 vs 1.4 ± 1.8, P = 0.0001, respectively). Methylprednisolone pulses and immunosuppressive therapy were more often used in patients with mixed forms (86.1 vs 60.6%, P = 0.016 and 83.3 vs 57.5%, P = 0.008, respectively). After a mean follow-up of 156.5 ± 104.5 months, there was no difference in the 2 subgroups concerning the number of patients achieving remission and patient/renal survival (94.5 vs 94.0% and 85.8 vs 86% at 10 years). At multivariate analysis, serum creatinine at presentation ( P = 0.0013), chronicity index ( P = 0.007), failure of achieving remission ( P = 0.000001), and occurrence of nephritic flares ( P = 0.00167) were independent predictors of chronic renal insufficiency. Conclusions Despite the differences in clinical and histological presentation, a therapy tailored on the grounds of clinical and histological features may reduce the differences in the outcome of white patients with mixed and pure membranous nephritis.