title: Severe lupus nephritis: the predictive value of a ≥ 50% reduction in proteinuria at 6 months.
abstract: BACKGROUND
  A complete remission (CR) in severe lupus nephritis (SLN) is associated with a favorable long-term outcome. Initial therapy may be up to 6 months, but many patients do not achieve a CR until after 12 months. We assess the value of a ≥50% reduction in proteinuria (UPro) at 6 months in predicting the outcome in SLN patients.
  
  
  METHODS
  We evaluated the 86 adult patients in the prospective, controlled trial of plasmapheresis (PP) in SLN (NEJM 1992). Patients with a CR (n = 12), end-stage renal disease (ESRD) or death (n = 13) at ≤6 months were excluded. The remaining 61 patients were categorized into two groups based on having attained a ≥50% reduction in UPro at 6 months: (yes) 34 patients and (no) 27 patients. The long-term outcomes were compared. A CR was defined by a serum creatinine (SCr) of ≤1.4 mg/dL and UPro of ≤0.33 g/day.
  
  
  RESULTS
  Baseline features were similar, but the UPro was higher (7.1 ± 3.6 versus 4.6 ± 3.2, P 0.002) in the group with a ≥50% reduction in UPro at 6 months. At follow-up, a CR was attained in 56% of patients with a ≥50% reduction in UPro at 6 months compared with 22% (P = 0.009) in the group without. The 15-year renal survival (71 versus 25%, P = 0.005) and patient survival without ESRD (66 versus 18%, P = 0.004) was greatest in the patients with a ≥50% reduction in UPro at 6 months.
  
  
  CONCLUSIONS
  A ≥50% reduction in UPro at 6 months predicts a favorable outcome in SLN.
authors.affiliation: Section of Nephrology, Department of Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Korbet
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Lewis
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D010956:Plasmapheresis; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D012074:Remission Induction; D015996:Survival Rate; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: proteinuria; remission; severe lupus nephritis