Long-term Outcome of Lupus Nephritis Class II in Argentine Patients

Abstract

BackgroundThere 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.MethodsA 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.ResultsForty-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).ConclusionsThis 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.

The long-term outcomes and histological transformation in class II lupus nephritis

“…Predicting those patients who will progress to other classes will help clinicians define the optimal time to begin therapy and increase remission rates. Collado et al 11 showed HT in 17 patients (41.4%) in a study of Argentine patients with LN class II. Pakozdi et al 8 reported a rate of HT of 63% in patients with LN class II.…”

“… 4 , 6 In our study, we observed complete remission in 23 patients (92%) of those treated with prednisolone alone at a dosage of 0.5-1 mg/kg. Collado et al 11 reported that 70% of their patients responded to treatment with corticosteroids at a dosage of 0.5 to 1 mg/kg per day. A lower rate of remission was also observed in the study carried out by Collado et al, 11 in which 29% of the 34 patients with LN class II were in complete remission at one year.…”

“…Collado et al 11 reported that 70% of their patients responded to treatment with corticosteroids at a dosage of 0.5 to 1 mg/kg per day. A lower rate of remission was also observed in the study carried out by Collado et al, 11 in which 29% of the 34 patients with LN class II were in complete remission at one year. Clinicians may need to consider the initial clinical presentation of patients with class II LN.…”

“…Moreover, patients with LN class II are at higher risk of histological transformation compared to other ISN/RPS classes, 7 which might change their prognosis and disease management. 8 - 11 The main objective of this study is to assess how patients with LN class II respond to immunosuppressive therapy, their long-term prognosis and their histological transformation to other ISN/RPS classes in a repeated biopsy.…”

Systemic lupus erythematosus, lupus nephritis and end-stage renal disease: a pragmatic review mapping disease severity and progression

“…However, this was a small study in which only 18 patients had a second biopsy. 38 Histological transformations were more common from non-proliferative lesions (class II and class V) compared with proliferative lesions (class III and class IV). 28,32,[38][39][40]…”