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- Title
Outcome of relapse in lupus nephritis: Roles of reversal of renal fibrosis and response of inflammation to therapy.
- Authors
Hill, Gary S; Delahousse, Michel; Nochy, Dominique; Thervet, Éric; Vrtovsnik, François; Rémy, Philippe; Glotz, Denis; Bariéty, Jean
- Abstract
Background. Renal relapse in lupus nephritis has been shown to have ominous prognostic significance with the majority of patients progressing to doubling of serum creatinine (CRX2). However, not all patients do so. This report explores the roles of response of inflammation to therapy and of glomerular scarring and interstitial fibrosis and their potential reversal to outcome of renal relapse. Methods. Renal biopsies from 71 patients with lupus nephritis with an initial biopsy (Bxl) and systematic control biopsy (Bx2) after six months of therapy, as well as subsequent biopsies for clinical indications, were studied. The relationships of morphologic factors to renal relapse and its outcome as well as to CRX2 and end-stage renal disease (ESRD) were analyzed. Cox proportional hazards modeling was used to assess association of morphologic variables with outcomes. Results. Renal interstitial fibrosis and glomerular segmental scarring were partially reversible in 17 and 11 patients, respectively. This decline was associated with an excellent prognosis, with only one patient in each group (5.9% and 9.1% respectively) progressing to CRX2. All 18 patients who progressed to CRX2 either failed to respond to therapy (7 patients) as defined by normalization of serum creatinine (S[sub Cr]) and reduction of proteinuria to ≤1 g/day, or relapsed after initial response (11 patients), as defined by recent rise of S[sub Cr] >50% and/or proteinuria >3.5 g/day. However, relapse also occurred in 11 of 47 other patients without progression to CRX2. These patients showed a greater initial response of inflammation and deposits to therapy and fibrous lesions partially reversed in the period prior to relapse, so that active lesions were superimposed on a lower level of chronic lesions. By contrast, chronic lesions mounted steadily in those who progressed to CRX2. Cox proportional hazards modeling indicated a strong association of inflammatory variables with renal relapse, CRX2 and ESRD....
- Subjects
LUPUS nephritis; DISEASE relapse; COLLAGEN diseases; KIDNEYS; INFLAMMATION
- Publication
Kidney International, 2002, Vol 61, Issue 6, p2176
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1046/j.1523-1755.2002.00357.x