HDCN Article Review/Hyperlink

Sloan RP, Schwartz MM, Korbet SM, Borok RZ, for the Lupus Nephritis Collaborative Study Group

Long-term outcome in SLE membranous glomerulonephritis

J Am Soc Nephrol (Feb) 7:299-305 1996

The objective of this study was to determine if the pathological subtype of membranous SLE (SLE MGN) affects prognosis. It was a retrospective clinicopathologic study of 79 patients with SLE MGN biopsied at Rush-St Luke's Medical Center between 1974 and 1993 or by the Lupus Nephritis Collaborative Study Group between 1981 and 1986. Patients were classified using the WHO classification scheme as pure MGN without (WHO Va) or with (WHO Vb) mesangial hypercellularity, and as MGN with segmental (WHO Vc) or diffuse (WHO Vd) endocapillary proliferation and/or necrosis. <BR><BR> WHO Vc with >50% glomerular involvement and Vd were associated with increased serum creatinine concentration, urine protein excretion, blood pressure, and decreased C3. 5-year actuarial renal or patient survival rates were 86, 72, and 49% for Va plus Vb, Vc with <50% glomerular involvement, and Vc with >50% involvement plus Vd, respectively. On multivariate analysis, elevated serum creatinine was the only clinical predictor of poor outcome; serum albumin, C3, urine protein, blood pressure, and age were not predictive. Virtually all patients were treated with prednisone; most patients with proliferative lesions received cytotoxic agents.

Comment: The prognosis of patients with pure SLE MGN is relatively favorable; optimal treatment of these patients should be determined by a multicenter randomized controlled trial. (David J Leehey, M.D., Loyola University School of Medicine)