title: Prognosis of proliferative lupus nephritis subsets in the Louvain Lupus Nephritis inception Cohort.
abstract: OBJECTIVE
  The objective of this paper is to evaluate whether the different International Society of Nephrology/Renal Pathology Society (ISN/RPS) classes of proliferative lupus nephritis (LN) have a distinct baseline presentation, short-term response to immunosuppression (IS) and long-term prognosis.
  
  
  METHODS
  Ninety-eight patients with new onset (first renal biopsy) ISN/RPS proliferative LN (Class III: n=24; IV-S: n=23; IV-G: n=51) were diagnosed at our institution between 1995 and 2012 (Louvain Lupus Nephritis inception Cohort). Their baseline renal parameters, primary response to IS at one year, survival and long-term renal outcome (mean follow-up: 77 months) were compared.
  
  
  RESULTS
  At baseline, serum creatinine and 24-hour proteinuria were higher in Class IV-G, as was activity index on renal biopsy in Class IV-S and IV-G compared to III. Upon treatment, renal parameters improved with the same kinetics and to the same extent in the three pathological classes. On repeat renal biopsies (n=43), activity indices dropped similarly. Poor outcomes (death, end-stage renal disease, renal impairment defined by an eGFR <60 ml/min/1.73 m(2)) did not statistically differ between groups, although there was a trend toward more renal impairment at follow-up in Class IV-G compared to IV-S and III. Finally, the presence of even mild chronic lesions on baseline biopsy was clearly predictive of late renal outcome.
  
  
  CONCLUSIONS
  Subsetting proliferative LN into Class III, IV-S and IV-G provides less clinically discriminant prognostic information than baseline chronicity index.
authors.affiliation: Department of Rheumatology; Department of Pathology; Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; 4Pôle de Pathologies Rhumatismales; and Pôle de Néphrologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Vandepapelière
authors.forename: S
authors.initials: S
authors.lastname: Aydin
authors.forename: J-P
authors.initials: JP
authors.lastname: Cosyns
authors.forename: G
authors.initials: G
authors.lastname: Depresseux
authors.forename: M
authors.initials: M
authors.lastname: Jadoul
authors.forename: F A
authors.initials: FA
authors.lastname: Houssiau
mesh_terms: D000328:Adult; D001530:Belgium; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D008181:Lupus Nephritis / Q000145:classification* / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Lupus nephritis; classification; outcome; pathology; subsets