Predictive value of clinical, laboratory, pathologic, and treatment variables in steroid/immunosuppressive resistant lupus nephritis.
Twenty-seven patients with lupus nephritis and nephrotic syndrome had persistent disease activity despite an adequate trial of corticosteroids and immunosuppressive drugs; 30% were Asians, compared with 7% of our overall SLE population. Two years later, seven had a very good outcome and seven a poor outcome. Thirty clinical, pathological, laboratory, and treatment variables were analyzed in a good versus poor responder subset comparison in an effort to determine which factors were associated with favorable outcome. Administration of pulse steroids (P = .069) and a low biopsy chronicity index (P = .048) were associated with the good responder subset. Serum creatinine, biopsy class, blood pressure, complement, and anti-DNA values at entry as well as the choice of immunosuppressive drug were not helpful in predicting outcome. All seven good responders were plasmapheresed (P = .026). Patients with refractory lupus nephritis who have a low biopsy chronicity index may benefit from the use of pulse steroids or plasmapheresis, and controlled studies are suggested.
Wallace
D J
DJ
Department of Medicine, UCLA School of Medicine.
Goldfinger
D
D
Savage
G
G
Nichols
S
S
Goodman
D
D
Fichman
M
M
Stewart
M
M
Klinenberg
J R
JR
D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008181:Lupus Nephritis / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D008297:Male; D009404:Nephrotic Syndrome / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D010956:Plasmapheresis / Q000379:methods*; D011379:Prognosis
D005938:Glucocorticoids; D007166:Immunosuppressive Agents