Contribution of renal biopsy data in predicting outcome in lupus nephritis: analysis of 116 patients

✍ Scribed by Hans C. Nossent; Sonja C. Henzen-Logmans; Thea M. Vroom; Jo H. M. Berden; Tom J. G. Swaak

• Publisher: John Wiley and Sons
• Year: 1990
• Tongue: English
• Weight: 647 KB
• Volume: 33
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780330708

✦ Synopsis

We reassessed renal biopsy specimens from 116 patients with systemic lupus erythematosus and clinical manifestations of lupus nephritis to determine the contributions of the World Health Organization classification system, the activity and chronicity indexes of the National Institutes of Health scoring system, and various clinical parameters at the time of biopsy to predicting disease outcome. Multivariate analysis showed that only a chronicity index >3 was predictive for decreased renal survival, while age >31 years at biopsy and a chronicity index >3 were associated with decreased patient survival. Clinical tests of renal function were not reliable in discriminating between active lesions and chronic renal damage.

Despite recent impressive improvements in patient survival compared with the presteroid era, renal disease secondary to systemic lupus erythematosus (SLE) is still associated with high morbidity and mortality rates (14). At present, uncertainty still exists about the prognostic value of various parameters in lupus nephritis, but recent cumulative evidence indicates that the presence of the following parameters at biopsy is associated with increased risk for renal failure: young age (<23 years), increased serum creatinine levels, diffuse proliferative lesions (World Health Organization [WHO] class IV), and a high chronicity index on renal histologic analysis (4-10).

In this study, we analyzed 116 SLE patients with clinical evidence of lupus nephritis to determine the contribution of various factors to their prognosis and, in particular, the merits of evaluating renal histology in these patients. We also examined possible correlations between clinical and histologic data at the time of renal biopsy to see if the biopsy findings could have been predicted by simple clinical data determined at the time of biopsy.