Value of a complete or partial remission in severe lupus nephritis.
OBJECTIVE
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.


METHODS
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 < or =1.5 g/d and < or =25% increase in baseline creatinine) and complete remission (proteinuria < or =0.33 g/d and serum creatinine < or =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.


CONCLUSIONS
Even a partial remission in lupus nephritis is associated with a significantly better patient and renal survival compared with no remission.
Chen
Yiann E
YE
Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Korbet
Stephen M
SM
Katz
Robert S
RS
Schwartz
Melvin M
MM
Lewis
Edmund J
EJ
D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008181:Lupus Nephritis / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome