Journal Article

Complete remission in severe lupus nephritis: assessing the rate of loss in proteinuria

Stephen M. Korbet and Edmund J. Lewis

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 7, pages 2813-2819
Published in print July 2012 | ISSN: 0931-0509
Published online December 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr741
Complete remission in severe lupus nephritis: assessing the rate of loss in proteinuria

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Background

The prognosis of severe lupus nephritis (SLN) is improved in patients attaining a complete remission (CR). The time to remission ranges from 10 to 16 months with many patients not attaining a CR until after 12 months. We assessed whether the rate of loss in proteinuria (UPro) is predictive of a CR in SLN patients.

Methods

We studied 85 adult patients in the prospective controlled trial of plasmapheresis in SLN (New England Journal of Medicine 1992). All patients had International Society of Nephrology/Renal Pathology Society Class IV ± Class V lesions. All patients received prednisone and oral cyclophosphamide and 39 patients received plasmapheresis. A CR was defined by a serum creatinine (SCr) of ≤1.4 mg/dL and UPro of ≤0.33 g/day. The change in UPro in gram per day per week was determined at 3 and 6 months from entry to the study.

Results

A CR was attained in 37 patients (44%) by 16 ± 14 months. The level of UPro at baseline was similar in CR and no remission (NR) patients (5.5 versus 6.4 g/day), but CR patients had a lower SCr (1.2 versus 2.4, P < 0.0001). At 6 months, the rate of change of UPro was higher at (−)0.224 g/day/week in CR patients and (−)0.107 g/day/week in NR patients (P = 0.01) and a 50% reduction in UPro was seen in 78% of CR patients but only 42% of NR patients (P = 0.009). The time to a CR was ≤12 months in 19 patients and >12 months in 18 patients. The baseline SCr was similar among the two groups. However, UPro at baseline was lower in patients with CR in ≤12 months (3.9 ± 2.7 versus 7.2 ± 3.0 g/day, P = 0.001) but the proportion of patients with membranous glomerulonephritis was similar (16 versus 22%). The rate of change in UPro at 6 months was similar at (−)0.214 g/day/week in patients with CR ≤12 months and (−)0.235 g/day/week in those with CR >12 months (P = 0.6). At 6 months, a 50% reduction in UPro was also similar in the two groups (84 versus 72%, P = 0.4). Additionally, the rate of change in UPro at 3 and 6 months was similar within each group.

Conclusions

The rate of change in proteinuria at 6 months is significantly greater in patients attaining a CR relative to NR patients but similar in patients with a CR in ≤12 months or >12 months. Thus, the rate of loss of UPro at 6 months may help in predicting which patients will attain a CR.

Keywords: proteinuria; remission; severe lupus nephritis

Journal Article.  4258 words. 

Subjects: Nephrology

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