Class V lupus nephritis: a clinicopathologic study in 152 patients.
BACKGROUND
Class V lupus nephritis (LN) can be divided into two subgroups according to the 1995 WHO modified classification, but the difference in clinical characteristics between these subgroups is not well known.


METHODS
We classified 152 patients with Class V LN, confirmed by renal biopsy, into two subgroups (61 Class Va, 91 Class Vb), and enrolled 488 patients with Class IV as controls. The clinical manifestations, serologic results and prognosis were compared for Classes Va and Vb.


RESULTS
The incidence of hypertension and anemia in Class Vb patients was significantly higher than in Class Va (38.5% vs 21.3%, 72.5% vs 52.5%, p<0.05). The incidence of hematuria and renal insufficiency in Class Vb was 64.8%and 15.4%, which was higher than Class Va (44.2% and 3.3%), but lower than Class IV (89.1% and 35%), p<0.05. The percentage of patients with positive anti-dsDNA antibody and hypocomplementemia in Class Vb tended to be higher than Class Va (35.2% vs 26.2%, 50.6% vs 31.2%). Repeated renal biopsies in 24 patients (11 Class Va, 13 Class Vb) showed that eight Class Vb patients had "transformed" to Class IV LN, while only two Class Va patients did (p<0.05). In three Class Va patients serum creatinine doubled during follow-up, but none of them progressed to end-stage renal disease (ESRD). In Class Vb serum creatinine doubled in ten patients, and three progressed to ESRD.


CONCLUSIONS
The renal injury and extrarenal manifestations of Class Vb patients were severer than Class Va. Class Vb patients were more likely to shift to Class IV LN, and the prognosis was poorer than for Class Va.
Chen
Qiang
Q
Department of Nephrology, Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, China. qiangchen@vip.sina.com
Liu
Zhihong
Z
Hu
Weixin
W
Chen
Huiping
H
Zeng
Caihong
C
Li
Leishi
L
D000328:Adult; D001707:Biopsy, Needle; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality; D007677:Kidney Function Tests; D008181:Lupus Nephritis / Q000145:classification* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate