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
