Prognostic value of renal biopsy and clinical variables in patients with lupus nephritis and normal serum creatinine

Jacobsen, Henrik Starklint Søren

doi:10.1080/03009749950155472

Cited by 13 publications

(3 citation statements)

References 24 publications

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“…Few studies in the pediatric literature have analyzed the risk factors for renal failure in childhood LN. Our results confirm and support the previous observations that several clinical indicators of disease severity are potentially important prognostic factors [1, 4, 15, 16, 21, 27]. We demonstrated that those with class IV LN, impaired renal functions or nephrotic syndrome at initial evaluation were at high risk for reaching the endpoints of renal failure or death despite all aggressive treatment.…”

Section: Discussionsupporting

confidence: 81%

“…Histopathological findings and demographic data including race, age, sex, clinical and serological features have been investigated to predict the prognosis of LN in adults and also children [5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 21, 22]. The results still remain controversial, and most authors consider the presence of class IV (diffuse proliferative) nephritis, high creatinine clearance ratio (Ccr), persistent hypertension, the age of onset before 12 years, male sex and black race as significant poor prognostic parameters of LN [4, 9, 10, 12, 15, 20, 21, 22, 23, 24, 25, 26, 27, 28]. …”

Section: Introductionmentioning

confidence: 99%

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Lupus Nephritis in Children: Prognostic Significance of Clinicopathological Findings

Emre

Bilge

Şirin

et al. 2001

Nephron

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Background: We aimed to review our experience with childhood lupus nephritis (LN) in respect to the analysis of the clinical and histopathological presentation of LN and prognostic factors affecting the kidney and patient outcomes. Method: Forty-three children (39 girls, 4 boys) with biopsy-proven LN were included in the study. The mean age of the children was 12.0 ± 2.8 years. Based on the renal histopathology and clinical presentation, patients were treated with oral prednisone, intravenous pulses of methylprednisolone or intravenous cyclophosphamide. The final clinical status was classified as follows: (1) renal and extrarenal remission; (2) clinically active renal disease, or (3) adverse outcome, i.e., end-stage renal failure (ESRF) or death. Results: The mean duration of follow-up was 7.2 ± 2.8 years (1 month to 14.2 years). All 43 children had hematuria and 53.5% had proteinuria at admission. Fourteen children were in nephrotic status at the onset of disease. Class IV (diffuse proliferative) nephritis was observed in 29 patients as the most frequent histopathology (67.4%). The patients with class IV nephritis had a tendency to develop nephrotic syndrome, heavy proteinuria, increased Cr levels and persistent hypertension at initial evaluation. Thirty-two of 43 children (74.4%) were in renal remission at the last visit. Five-year kidney and patient survival rates from the time of diagnosis to the endpoints of ESRF or death were 83.7 and 90.7% respectively in the whole group while it was 75.9 and 86.2% respectively in the class IV group. Adverse outcome was significantly associated with the persistent hypertension, anemia, high serum Cr level, heavy proteinuria, nephrotic syndrome and class IV nephritis at presentation. Conclusion: We can conclude that the prognosis of LN in children is primarily dependent on the histopathological lesions. Severity of the clinical renal disease at admission and presence of persistent hypertension are the main poor prognostic factors rather than age, gender, low C3 and C4 levels, ANA positivity and the treatment modalities in Turkish children.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Lupus Nephritis in Children: Prognostic Significance of Clinicopathological Findings

Emre

Bilge

Şirin

et al. 2001

Nephron

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“…Despite improvements in outcomes of immunosuppressive treatment of patients with lupus nephritis, renal remission is obtained in less than 50% of cases within 2 years; approximately 10% may progress to end-stage renal disease [83,84], which is associated with significantly increased rates of cardiovascular mortality [85]. In general, patients with SLE and renal involvement have more cardiovascular disease than the remaining SLE patients [86,87].…”

Section: Potential Implications Of Data On Murine Lupus Nephritis Formentioning

confidence: 99%

Chromatin as a target antigen in human and murine lupus nephritis

2011

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The present review focuses on pathogenic molecular and transcriptional events in patients with lupus nephritis. These factors are renal DNaseI, exposed chromatin fragments and the corresponding chromatin-reactive autoantibodies. Lupus nephritis is the most serious complication in human systemic lupus erythematosus, and is characterised by deposition of chromatin fragment-IgG complexes in the mesangial matrix and glomerular basement membranes. The latter deposition defines end-stage disease. This event is stringently linked to a renal-restricted shutdown of expression of the DNaseI gene, as determined by loss of DNaseI mRNA level and DNaseI enzyme activity. The major aim of the present review is to generate new therapeutic strategies based on new insight into the disease pathogenesis.

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Myth: Kidney biopsy is indicated in every case of lupus nephritis

Vitievsky¹

2002

Myths and Shibboleths in Nephrology

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Prognostic value of renal biopsy and clinical variables in patients with lupus nephritis and normal serum creatinine

Abstract: Early renal biopsy and the abovementioned signs of active renal disease carry prognostic information that may have significant therapeutic implications.

Cited by 13 publications

References 24 publications

Lupus Nephritis in Children: Prognostic Significance of Clinicopathological Findings

Lupus Nephritis in Children: Prognostic Significance of Clinicopathological Findings

Chromatin as a target antigen in human and murine lupus nephritis

Myth: Kidney biopsy is indicated in every case of lupus nephritis

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