title: [Relationship between initial diagnosis and long-term prognosis in lupus nephritis].
abstract: To clarify the outcomes of patients with lupus glomerulonephritis (LGN), we performed a retrospective study of 31 patients (27 females and 4 males) with LGN between January 1975 and June 2006. All these 31 patients fulfilled the SLE criteria of the American College of Rheumatology evaluated by pathohistological diagnosis using renal biopsies. According to 2003 ISN/RPS classification, we reclassified all initial renal biopsies as class II 16%, class III 16%, class IV 48%, and class V 19.5%. Activity and chronicity indices were also calculated according to the scores proposed by Austin et al. All patients were treated by oral corticosteroids in induction therapy, then subsequeatly 18 patients (61%) were treated with intravenous methylprednisolone pulse therapy, and 16 patients with immunosuppressive agents (58%). Clinical remission rate was 94% by induction therapy and 13% by recurrence rate. Patient survival rate was 85% at 10 years and 76% at 20 years. Renal survival rate was 96% at 10 years and 86% at 20 years, 100% at 10 years and 80% at 20 years in ClassIV-G. In the multivariate Cox hazard analysis of the clinicopathologic factors, serum creatinine was selected as the most significant risk factor for death and/or end-stage renal failure (p=0.036). In addition, the chronicity index was also a significant risk factor for renal survival of LGN.
  
  
  CONCLUSIONS
  This retrospective analysis of LGN showed better outcomes than expected. Overall, early diagnosis and suitable initial therapy may improve the renal survival of LGN in both groups of patients.
authors.affiliation: Division of Nephrology, Kanazawa Medical University, Ishikawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okuyama
authors.forename: Syogo
authors.initials: S
authors.lastname: Kimura
authors.forename: Hirokatsu
authors.initials: H
authors.lastname: Atsumi
authors.forename: Junko
authors.initials: J
authors.lastname: Imura
authors.forename: Keiji
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Chikazawa
authors.forename: Suguru
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Imamura
authors.forename: Hideki
authors.initials: H
authors.lastname: Yamaya
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Asaka
authors.forename: Naohisa
authors.initials: N
authors.lastname: Tomosugi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yokoyama
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D002648:Child; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000473:pathology; D008181:Lupus Nephritis / Q000145:classification / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003404:Creatinine; D008775:Methylprednisolone