title: Glomerulomegaly in lupus nephritis: a prognostic marker for renal outcomes.
abstract: OBJECTIVE
  Glomerulomegaly refers to the abnormal enlargement of glomeruli and is associated with an increased risk of progressive chronic kidney disease (CKD). However, it has rarely been investigated in lupus nephritis (LN). We therefore assessed glomerulomegaly as a prognostic factor for renal pathology.
  
  
  METHODS
  Patients with class III or IV LN were retrospectively recruited and divided into two groups according to complete renal response (CR) at 3 years after the initiation of induction therapy. Baseline clinical and renal pathological findings were compared to identify prognostic factors, and patients were followed for up to 10 years to assess long-term renal outcomes.
  
  
  RESULTS
  Nineteen patients with and 19 without CR on 3-year follow-up were analyzed. Long-term disease duration and high levels of proteinuria were frequently observed in patients without CR (P = 0.03 and P = 0.01, respectively) at baseline compared to those with CR. On renal pathological analysis, a significantly higher proportion of patients without CR had enlarged glomeruli than those with CR (P = 0.03) in analysis of segmentally or minimally affected glomeruli. On 10-year follow-up, a higher proportion of patients without enlarged glomeruli maintained CR compared to those with enlarged glomeruli (P = 0.004). Further, glomerular area and disease duration were significantly correlated (P = 0.04).
  
  
  CONCLUSIONS
  Enlarged segmentally or minimally affected glomeruli at diagnosis of LN might predict a worse renal prognosis at 3 years after induction therapy. Mechanical glomerular injury might influence clinical outcomes.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hironari
authors.initials: H
authors.lastname: Hanaoka
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.|Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kuwana
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeuchi
mesh_terms: D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007678:Kidney Glomerulus / Q000187:drug effects / Q000473:pathology*; D008181:Lupus Nephritis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: glomerulomegaly; lupus nephritis; systemic lupus erythematosus