The Clinical Course of the Proliferative and Membranous Forms of Lupus Nephritis

Baldwin, David S.; Lowenstein, Jerome; Rothfield, Naomi F.; Gallo, Gloria; McCluskey, Robert T.

doi:10.7326/0003-4819-73-6-929

Cited by 259 publications

(98 citation statements)

References 16 publications

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“…Death occurred in these patients after an average interval of 4.6 years, while all 6 of the patients with either mesangial glomerulitis or membranous glomerulonephritis are still living after an average follow-up of 9.4 years. This confirms previous observations (3,4,6,7,9,10) that proliferative nephritis is associated with a poor prognosis.…”

Section: Discussionsupporting

confidence: 81%

“…Baldwin and co-workers have reported that patients with this type of renal lesion have a relatively benign prognosis (9). However, it is likely that the category of mesangial glomerulitis, which was utilized in the present report for patients with hypercellularity and/or sclerosing changes restricted to the mesangium, would have been classified by Baldwin and co-workers in the category of focal proliferative lupus nephritis.…”

Section: Discussioncontrasting

confidence: 39%

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Renal histology and clinical course of systemic lupus erythematosus

Cheatum

Hurd

Strunk

et al. 1973

Arthritis & Rheumatism

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Thirty women with systemic lupus erythematosus were categorized into groups with and without significant renal involvement on the basis of renal biopsy and subsequently followed for an average of 9.4 years. At this time 53% of the patients with renal disease and 70% of the "nonrenal" patients had died. While 80% of the deaths in the "renal" group were due to renal disease, none of the nonrenal patients died of this complication. Major central nervous system involvement was eventually noted in 100% of the nonrenal group. After 8.3 years, mortality in the nonrenal patients exceeded that in the renal group, mainly because of the emergence of central nervous system disease.Although a number of reports have dealt with the renal involvement (1 -8) and long-term prognosis (3, 5, 6, 9-1 1) of patients with systemic lupus erythematosus (SLE), there has been a paucity of data concerning the ultimate prognosis of patients without significant renal involvement ( 5 , 7 , 8,10). In the present study a group of SLE patients has been classified ac- cording to their renal histology, and their rlinical course documented over a prolonged followup period which averaged 9.4 years. MATERIALS AND METHODSThis prospective study was conducted among patients admitted to Parkland Memorial Hospital during the years [1960][1961][1962][1963][1964][1965][1966][1967]. During this interval, 48 patients with SLE were hospitalized one or more times; all fulfilled the diagnostic criteria of the American Rheumatism Association (12). Ropes (13), and the British Medical Research Council (14) for SLE. Of the 48 patients, 30 females (21 black, 6 white, 3 Latin American: mean age 30.8 years, range 8 to 63 years) were included in the study on the basis of availability of a renal biopsy on admission and continued attendance in the outpatient clinic. Biopsies were performed without regard to the presence or absence of clinical evidence of renal disease. The date of onset of SLE was arbitrarily chosen as the time when the patient was first hospitalized with definite symptoms of SLE. All patients seen in the Arthritis Clinic with SLE were hospitalized one or more times during the period of the study. Admissions to the study were closed in 1967, and the patients were followed in the outpatient clinic by their respective physicians until January 1972, when all records were reviewed. The mean follow-up period was 9.4 years, ranging from 11 months, when death intervened in 1 case, to 15.5 years.Although cyclophosphamide and 6-mercaptopurine were used in 9 of the 30 patients studied, these were administered merely as an adjunct to steroid therapy and only in the final 670

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Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 39%

Renal histology and clinical course of systemic lupus erythematosus

Cheatum

Hurd

Strunk

et al. 1973

Arthritis & Rheumatism

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“…There were no instances of infection without C R P positivity, but it is possible that minor urinary tract or skin infections were not recorded. It is unlikely that major infections were undiagnosed because of the close clinical and laboratory observations made in this research clinic (10). Indeed it is the major infections that one has difficulty differentiating from very active disease in SLE patients.…”

Section: Discussionmentioning

confidence: 99%

C‐Reactive Protein in Systemic Lupus Erythematosus

Honig

Gorevic

Weissmann

1977

Arthritis & Rheumatism

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The presence of C-reactive protein (CRP) was determined in the sera of 70 patients with systemic lupus erythematosus (SLE), 24 patients with rheumatoid arthritis (RA), and 17 patients hospitalized with acute infections. CRP (precipitin reaction > 3 mm) was present in only 2 of 50 patients with active, uncomplicated SLE (4%). However CRP was found in the sera of 11 patients with active SLE in the presence of superimposed infection. Treatment of the intercurrent infection resulted in the loss of CRP from the sera of these SLE patients. CRP was found in 85% of patients with active RA and in 100% of non-SLE infected patients. Appropriate treatment of the latter group resulted in loss of CRP from the convalescent sera. Corticosteroid therapy did not appear to influence the presence of CRP in the RA or SLE groups. Fourteen of 50 noninfected patients (28%) with active SLE were not receiving steroids at the time of CRP negativity. Appropriate experiments with mixed sera failed to demonstrate serum factors that could influence CRP precipitation in the CRP-negative SLE group. These studies suggest that patients with active SLE usually do not have CRP in their sera, and the results distinguish this group of patients from those with active RA, a disease generally marked by CRP positivity. Moreover, the finding of significant CRP precipitin in the sera of SLE patients may suggest the presence of superimposed infection.C-reactive protein (CRP) was first described by Tillet and Francis in 1930 in the sera of patients with pneumococcal pneumonia (1). Subsequently, its presence has been well documented in the sera of patients with rheumatic fever (2), rheumatoid arthritis (3-5), myocardial infarction, and other inflammatory states (3,6). The incidence of CRP in sera of patients with systemic lupus erythematosus is, however, not well established. To determine the incidence of CRP positivity in the sera of patients with SLE, 70 patients with SLE were studied. CRP positivity was then correlated with disease activity and superimposed infections. Seventeen non-SLE patients hospitalized with acute infections were studied to determine the duration of CRP positivity in various infectious states, and 24 patients with rheumatoid arthritis were also evaluated to assess the influence of corticosteroid therapy upon the presence of CRP in patients with a disease process known to be associated with CRP positivity (2).We utilized the semiquantitative, capillary precipitin reaction to determine the presence of CRP, rather than the more sensitive radioimmunoassay, which has demonstrated that minute amounts of CRP

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“…1970 Baldwin et al 41 described clinical histopathologic correlates of patients with focal proliferative LN, diffuse proliferative LN, or membranous LN. It was observed that in focal LN, for the most part, only small portions of glomeruli were affected, whereas in diffuse LN, usually larger portions of each glomerulus were involved.…”

Section: Endocapillary Proliferationmentioning

confidence: 99%

The Revisited Classification of GN in SLE at 10 Years

Wilhelmus

Alpers

Cook

et al. 2015

Journal of the American Society of Nephrology

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Over 10 years have passed since the latest revision of the histopathologic classification of lupus nephritis. This revision was a significant improvement compared with the previous version, mainly because of clearer and more concise definitions and the elimination of mixed subclasses. Despite these improvements, there are still some difficulties in the classification for lupus nephritis, many of which are in the definitions provided. In this review, we focus on the difficulties surrounding the evaluation of classes III and IV lesions, particularly the definitions of endocapillary and extracapillary proliferation, the use of the terms endocapillary proliferation and hypercellularity, the clinical relevance of segmental and global subdivision in class IV, and the value of distinguishing lesions that indicate activity and chronicity. Vascular and tubulointerstitial lesions are also discussed. Furthermore, we give an overview of the history of the classification to provide background on the origin and development of the definitions in lupus nephritis. The issues raised in this review as well as the suggestions for improvements may assist with a revision of the lupus nephritis classification in the near future.

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The Clinical Course of the Proliferative and Membranous Forms of Lupus Nephritis

Cited by 259 publications

References 16 publications

Renal histology and clinical course of systemic lupus erythematosus

Renal histology and clinical course of systemic lupus erythematosus

C‐Reactive Protein in Systemic Lupus Erythematosus

The Revisited Classification of GN in SLE at 10 Years

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