Value of a complete or partial remission in severe lupus nephritis

Yiann E. Chen, Stephen M. Korbert, Robert S. Katz, Melvin M. Schwartz, Edmund J. Lewis, J. L. Roberts, M. M. Schwartz, R. A. Rodby, H. L. Corwin, J. M. Lachin, S. P. Lan, P. Cleary, J. Bernstein, H. Shapiro, B. F. Rosenberg, M. A. Pohl, J. Clough, G. Gephardt, T. Berl, N. LevinL. G. Hunsicker, S. Bonsib, N. Simon, H. Friederici, F. del Greco, F. A. Carone, L. Hebert, H. M. Sharma, E. Nielson, J. Tomazewski, A. Levey, A. Ucci, J. Lemann, S. S. Blumenthal, J. Garancis, K. Shapiro, P. Chander, F. Whittier, J. W. Graves, J. Bathon, P. Riley, M. M. Schwartz, J. Bernstein, G. H. Hill, K. Holley

Research output: Contribution to journalArticlepeer-review

Abstract

Background and objectives: The value of a complete remission in severe lupus nephritis is well known but little is known about the impact of a partial remission in this patient population. The purpose of this study was to evaluate the long-term prognosis of achieving a complete or partial remission in a well-defined group of patients with severe lupus nephritis. Design, setting, participants, & measurements: In this study, 86 patients with diffuse lupus glomerulonephritis were reviewed for assessment of the value of a partial remission (50% reduction in baseline proteinuria to ≤1.5 g/d and ≤25% increase in baseline creatinine) and complete remission (proteinuria ≤0.33 g/d and serum creatinine ≤1.4 mg/dl) on outcomes compared with patients who did not attain a remission. These well-characterized patients were entered into a prospective therapeutic trial conducted by the Collaborative Study Group and were followed for more than 10 yr. Results: All biopsies showed diffuse lupus nephritis. A complete remission was attained in 37 (43%) patients, a partial remission in 21 (24%) patients, and no remission in 28 (32%) patients. Baseline clinical and serologic features were similar among the groups, but patients with a complete remission had a lower serum creatinine and chronicity index compared with patients with partial or no remission. The patient survival at 10 yr was 95% for complete remission, 76% for partial remission, and 46% for no remission. The renal survival at 10 yr was 94% for complete remission, 45% for partial remission, and 19% for no remission, and the patient survival without end-stage renal disease at 10 yr was 92% for complete remission, 43% for partial remission, and 13% for no remission. Conclusion: Even a partial remission in lupus nephritis is associated with a significantly better patient and renal survival compared with no remission.

Original languageEnglish (US)
Pages (from-to)46-53
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume3
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Medicine(all)

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