title: Progressive improvement of patient and renal survival and reduction of morbidity over time in patients with lupus nephritis (LN) followed for 20 years.
abstract: Whether the long-term patient and renal survival of those diagnosed with lupus nephritis (LN) has improved over the decades is still debated. Eighty-nine patients diagnosed between 1968 and 1990 entered this study and their outcome was evaluated after 20 years. At presentation 54% of patients had class IV LN, 39.3% had renal insufficiency and 59.5% had nephrotic syndrome. Patients were divided into two groups: Group 1 consisted of 30 patients diagnosed between 1968 and 1980; Group 2 consisted of 59 patients diagnosed between 1981 and 1990. In Group 1 patient survival at 20 years was 84% versus 95% in Group 2 (p=0.05). Survivals without end-stage renal failure were respectively 75% and 84% at 20 years (p=0.05). Survivals without severe infection at 20 years were 44% in Group 1 and 66.5% in Group 2 (p=0.02). Survivals without cardiovascular events at 20 years were: 53% in Group 1 and 90% in Group 2 (p=0.005). At presentation, patients in Group 1 had higher serum creatinine (1.96 vs 1.15 mg/dl, p=0.01), higher activity index (8 vs 5.5, p=0.01), lower hematocrit (31% v s6%, p=0.008) and lower serum C4 levels (p=0.04) than Group 2 patients. Patients in Group 1 also received less frequent methylprednisolone pulses (43% vs 81%, p=0.0006). In Italian patients with LN, long-term life expectancy and renal survival progressively improved over the decades, while morbidity progressively declined. An earlier referral and refinement of therapy achieved this goal.
authors.affiliation: Unita' Operativa di Nefrologia e Dialisi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena IRCCS, Italy. gmoroni@policlinico.mi.it
authors.forename: G
authors.initials: G
authors.lastname: Moroni
authors.forename: S
authors.initials: S
authors.lastname: Quaglini
authors.forename: B
authors.initials: B
authors.lastname: Gallelli
authors.forename: G
authors.initials: G
authors.lastname: Banfi
authors.forename: P
authors.initials: P
authors.lastname: Messa
authors.forename: C
authors.initials: C
authors.lastname: Ponticelli
mesh_terms: D000293:Adolescent; D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006400:Hematocrit; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology; D008017:Life Expectancy; D008181:Lupus Nephritis / Q000503:physiopathology*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009404:Nephrotic Syndrome / Q000453:epidemiology* / Q000209:etiology; D017063:Outcome Assessment, Health Care; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D003404:Creatinine; D008775:Methylprednisolone
keywords: Lupus patient survival; immunosuppressive therapy; lupus nephritis; lupus renal survival; methylprednisolone pulses; systemic lupus erythematosus