RESUMO
BACKGROUND: The long-term outcome of the pure form of WHO type V lupus membranous glomerulonephritis is apparently more benign than that of other forms of lupus glomerulonephritis. However 12% of such patients progress to terminal renal failure. The presence of proteinuria may be an indication of cytotoxic agents. AIM: To study the clinical long-term outcome of WHO type V lupus membranous glomerulonephritis. MATERIAL AND METHODS: A retrospective analysis of all kidney biopsies of a University Pathology Department, with the diagnosis of WHO type V lupus membranous glomerulonephritis. Review of medical records of patients with the disease and one clinical assessment of all living patients. RESULTS: Between 1973 and 2000, 703 kidney biopsies were done to patients with systemic lupus erythematosus. Of these, 40 were membranous glomerulonephritis and in 33 patients (28 women, age range 6-71 years), data on the evolution and survival was obtained. Nineteen had type Va and the rest type Vb nephritis. Two presented with renal failure and 11 with proteinuria over 3.5 g/24 h. The median follow-up since the renal biopsy was 63 months (range 1-316). At the end of follow-up, four had a creatinine clearance of less then 15 ml/h and four a clearance between 15 and 29 ml/h (one of these received a renal allograft). Eleven (33%) patients had died, mostly due to infections. Life expectancy at five years with a creatinine clearance over 15 ml/h was 75%. Bad prognostic factors were an elevated creatinine clearance over 15 ml/h was 75%. Bad prognostic factors were an elevated creatinine and high blood pressure at the moment of the biopsy. CONCLUSIONS: The clinical outcome of these patients was bad. Twelve percent reached a stage of terminal renal failure. This is in contrast with the 3% progression to a similar stage of proliferative glomerulonephritis treated with i.v. cyclophosphamide. New therapies for this condition must be sought.
Assuntos
Glomerulonefrite Membranosa , Nefrite Lúpica , Adolescente , Adulto , Idoso , Biópsia , Criança , Chile/epidemiologia , Feminino , Seguimentos , Glomerulonefrite Membranosa/tratamento farmacológico , Glomerulonefrite Membranosa/mortalidade , Glomerulonefrite Membranosa/patologia , Humanos , Nefrite Lúpica/tratamento farmacológico , Nefrite Lúpica/mortalidade , Nefrite Lúpica/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Background: The long-term outcome of the pure form of WHO type V lupus membranous glomerulonephritis is apparently more benign than that of other forms of lupus glomerulonephritis. However 12percent of such patients progress to terminal renal failure. The presence of proteinuria may be an indication of cytotoxic agents. Aim: To study the clinical long-term outcome of WHO type V lupus membranous glomerulonephritis. Material and methods: A retrospective analysis of all kidney biopsies of a University Pathology Department, with the diagnosis of WHO type V lupus membranous glomerulonephritis. Review of medical records of patients with the disease and one clinical assessment of all living patients. Results: Between 1973 and 2000, 703 kidney biopsies were done to patients with systemic lupus erythematosus. Of these, 40 were membranous glomerulonephritis and in 33 patients (28 women, age range 6-71 years), data on the evolution and survival was obtained. Nineteen had type Va and the rest type Vb nephritis. Two presented with renal failure and 11 with proteinuria over 3.5 g/24h. The median follow-up since the renal biopsy was 63 months (range 1-316). At the end of follow-up, four had a creatinine clearance of less then 15 ml/h and four a clearance between 15 and 29 ml/h (one of these received a renal allograft). Eleven (33percent) patients had died, mostly due to infections. Life expectancy at five years with a creatinine clearance over 15 ml/h was 75percent. Bad prognostic factors were an elevated creatinine clearance over 15 ml/h was 75percent. Bad prognostic factors were an elevated creatinine and high blood pressure at the moment of the biopsy. Conclusions: The clinical outcome of these patients was bad. Twelve percent reached a stage of terminal renal failure. This is in contrast with the 3percent progression to a similar stage of proliferative glomerulonephritis treated with i.v. cyclophosphamide. New therapies for this condition must be sought.
Assuntos
Adolescente , Adulto , Masculino , Humanos , Feminino , Criança , Pessoa de Meia-Idade , Glomerulonefrite Membranosa/mortalidade , Glomerulonefrite Membranosa/patologia , Glomerulonefrite Membranosa/tratamento farmacológico , Nefrite Lúpica/mortalidade , Nefrite Lúpica/patologia , Nefrite Lúpica/tratamento farmacológico , Biópsia , Chile/epidemiologia , SeguimentosRESUMO
51 patients, mainly adults, with idiopathic membranous glomerulonephropathy were studied to evaluate their clinical course and long-term prognosis. Glomerular lesions were classified into four groups, according to Ehrenreich and Churg: 5 had type I, 19 type II, 20 type III and 7 type IV lesions. The onset was marked by a nephrotic syndrome in 47 patients (92%). Hypertension was present in 41% and the serum creatinine was over 2 mg/dl in 17%. During the follow-up period (mean 42 months) clinical remission occurred in 7 cases, clinical improvement in 4 patients, renal insufficiency in 11 patients (with end-stage renal failure in 10 and the condition remained unchanged in 29 cases. The actuarial life-table survival at 5 and 15 years was 80% and 56% respectively, excluded the 5 patients with renal vein thrombosis. The retrospective comparison in patients who did (n = 29) or did not (n = 22) receive corticosteroids, shows a favorable outcome of treated patients. Poor prognostic indicators were: impaired renal function at time of diagnosis, and advanced histologic staging.