A Clinico-pathologic Correlation in Lupus Nephritis / 대한신장학회잡지

ABSTRACT

We evaluated the relationship between the clinical and pathologic characteristics in 37 patients with biopsy-proven lupus nephritis. The peak age at onset of the disease was in the 3rd(40.5%) and 4th(32.4%) decades. The male to female ratio was 1 8.3. According to the WHO classification, 18 patients(48.6%) were belonged to class IV, 11 patients(29.7%) to class V and 8 patients(21.6%) to class III. At initial evaluation, nephrotic syndrome was observed in 5 patients(62.5%) of class III, 10 patients(55.6%) of class IV, and 3 patients(27.3%) of class V. The hypertension was observed 11 patients (29.7%), among which 7 (38.9%) was belonged to class IV. In patients of class III, IV and V, the mean serum creatinine was within normal limit at initial evaluation, and it was not significant difference at final study. On biopsy, the occurance of anti-DNA antibody and ANA was 63.9% and 89.2%, retrospectively. In 28 patients who were followed for more than 6 months, patients with class III and class V could be managed effectively with oral steroid only, but those with class IV lesion required steroid pulse or oral cyclophosphamide therapy. Interestingly, complete remission was obtained in 4/15 patients(26.7%) of class IV, but none with class III or V. Death had occurred in 3 patients (2 in class IV and 1 in class V). The cause of death was extrarenal complication such as infection and vascular disease. In conclusion, the patients with class IV lupus nephritis showed higher serum creatinine level although not significant, higher incidence of hypertension and progression of chronic renal failure than the other classes. Though the patients with class IV needed for more aggressive treatment with steroid pulse or cyclophosphamide-steroid combination. Thus it is suggested that the improvement of proteinuria and clinical course is possible with careful immunosuppressive therapy in selected cases of class IV lupus nephritis.