title: Long-term Outcome of Lupus Nephritis Class II in Argentine Patients: An Open Retrospective Analysis.
abstract: BACKGROUND
  There is controversy in medical literature over the outcome of patients with lupus nephritis (LN) class II. The aim of this study was to explore the risk of histological transformation (HT) and possible factors related to negative response to treatment in patients with mesangial LN class II.
  
  
  METHODS
  A retrospective and multicenter study was carried out that includes patients who had received a diagnosis of LN class II on their first renal biopsy. Creatinine, urine sediment, and proteinuria were recorded at the time of the first biopsy, 6 months, and 1, 2, and 5 years after the first biopsy. Response to treatment, HT, and long-term outcome were evaluated.
  
  
  RESULTS
  Forty-one patients were included. The manifestation at first biopsy was proteinuria greater than 0.5 g/d in 28 patients (68.29%; 8 [28.57%] of 28 patients had nephrotic syndrome), hematuria in 18 patients (43.90%), and deterioration of renal function in 3 patients (7.31%). During the follow-up (median, 8 years; range, 1-35 years), a new biopsy was performed in 18 patients (43.90%), and in 17 patients (17/18 [94.44%]), there was HT. Median time at rebiopsy was 32 months (range, 11-305 months). Of the 18 patients who had a second biopsy, 10 (55.55%) were on hydroxychloroquine versus 100% (19/19) of patients who did not undergo the procedure (P = 0.001). A year after the first renal biopsy, there are data available from 34 patients; of them, 24 patients (70.58%) had achieved response, and 10 patients (29.41%) had no response (NR) (missing data in 7). A higher 24-hour urinary protein at 6 months was predictor of worse outcome at 1 year, with statistical significance difference for the nonresponder group (median proteinuria, 2.3 g/d [range, 0-4.7 g/d]) compared with responders (median proteinuria, 0.28 g/d [range, 0-1.7 g/d]) (P = 0.0133).In the long-term follow-up (5 years), HT was the main cause of unfavorable outcome and was measured in 78.57% of patients (11/14 patients).
  
  
  CONCLUSIONS
  This series shows a high rate of HT in long-term follow-up. Proteinuria at 6 months made it possible to set aside patients who will have an unfavorable outcome in the long term and who will thus benefit from a more aggressive treatment. The results suggest that hydroxychloroquine had a nephroprotective effect.
authors.affiliation: From the Instituto de InvestigacionesMédicas Alfredo Lanari, Caba, Argentina.
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Collado
authors.forename: Enrique
authors.initials: E
authors.lastname: Dorado
authors.forename: Silvia
authors.initials: S
authors.lastname: Rausch
authors.forename: Graciela
authors.initials: G
authors.lastname: Gomez
authors.forename: Marina
authors.initials: M
authors.lastname: Khoury
authors.forename: Federico
authors.initials: F
authors.lastname: Zazzetti
authors.forename: María
authors.initials: M
authors.lastname: Gargiulo
authors.forename: Lorena
authors.initials: L
authors.lastname: Suarez
authors.forename: Rafael
authors.initials: R
authors.lastname: Chaparro
authors.forename: Sergio
authors.initials: S
authors.lastname: Paira
authors.forename: Laura
authors.initials: L
authors.lastname: Galvan
authors.forename: Vicente
authors.initials: V
authors.lastname: Juarez
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pisoni
authors.forename: Mercedes
authors.initials: M
authors.lastname: Garcia
authors.forename: Liliana
authors.initials: L
authors.lastname: Martinez
authors.forename: Analia
authors.initials: A
authors.lastname: Alvarez
authors.forename: Clarisa
authors.initials: C
authors.lastname: Alvarez
authors.forename: Juan
authors.initials: J
authors.lastname: Barreira
authors.forename: Judith
authors.initials: J
authors.lastname: Sarano
mesh_terms: D000328:Adult; D001118:Argentina / Q000453:epidemiology; D001706:Biopsy / Q000379:methods; D003404:Creatinine / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D007677:Kidney Function Tests / Q000379:methods; D008181:Lupus Nephritis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D011507:Proteinuria / Q000175:diagnosis / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013995:Time
chemical_list: D003404:Creatinine