IJCM  Vol.8 No.12 , December 2017
Long-Term Outcome of 102 Cases of Lupus Nephritis: A Single-Center Cohort Study in Japan
Abstract: Background: The mortality rate is higher in SLE patients with lupus nephritis (LN) than in those without nephropathy. Objectives: The aim of this study was to identify the factors affecting the long-term renal outcome in 102 patients with LN. Methods: This was a retrospective cohort study. Logistic regression analysis was used in a model to determine how independent variables predicted the outcome. The survival analysis was based on the Kaplan-Meier curve with subjects censored for death. Results: The 15-year survival rate was 93.5%, and the renal function non-deterioration rate was 78.3%. No influence of individual types of immunosuppressant drugs used was found on the renal function deterioration rate. In this study, the results of analysis identified only daily urinary protein excretion level as having any significant effect on the risk of progression of LN to renal failure. Conclusions: These results suggest that remission induction therapy and maintenance therapy focused on long-term preservation of renal function need to be selected for LN patients with a high daily urinary protein value at the start of treatment and for LN patients who fail to show any reduction of the daily urinary protein excretion level to 0.5 g or less at one year after the biopsy.
Cite this paper: Kodama, M. , Uchida, K. , Karasawa, K. , Moriyama, T. and Nitta, K. (2017) Long-Term Outcome of 102 Cases of Lupus Nephritis: A Single-Center Cohort Study in Japan. International Journal of Clinical Medicine, 8, 668-679. doi: 10.4236/ijcm.2017.812062.

[1]   Cameron, J.S. (1999) Lupus Nephritis. Journal of American Society of Nephrology, 10, 413-424.

[2]   Ward, M.M. (2010) Access to Care and the Incidence of End-Stage Renal Disease Due to Systemic Lupus Erythematosus. Journal of Rheumatology, 37, 1158-1163.

[3]   Saxena, R., Mahajan, T. and Mohan, C. (2011) Lupus Nephritis: Current Update. Arthritis Research & Therapy, 13, 240.

[4]   Imran, T.F., Yick, F., Verma, S., Estiveme, C., Ogbonnaya-Odor, C., Iruvarudsothy, S., et al. (2016) Lupus Nephritis: An Update. Clinical and Experimental Nephrology, 20, 1-13.

[5]   Dhir, V., Aggarwal, A., Lawrence, A., Agarwal, V. and Misra, R. (2012) Long-Term Outcome of Lupus Nephritis in Asian Indians. Arthritis Care & Research (Hoboken), 64, 713-720.

[6]   Alarcon, G.S. (2011) Multiethnic Lupus Cohorts: What Have They Taught Us? Clinical Rheumatology, 7, 3-6.

[7]   Tektonidou, M.G., Dasgupta, A. and Ward, M.M. (2016) Risk of End-Stage Renal Disease in Patients with Lupus Nephritis, 1971-2015. A Systematic Review and Bayesian Meta-Analysis. Arthritis & Rheumatology, 68, 1432-1441.

[8]   Faurschou, M., Dreyer, L., Kamper, A.-L., Starklint, H. and Jacobsen, S. (2010) Long-Term Mortality and Renal Outcome in a Cohort of 100 Patients with Lupus Nephritis. Arthritis Care & Research (Hoboken), 62, 873-880.

[9]   Tesar, V. and Hruskova, Z. (2011) Treatment of Proliferative Lupus Nephritis: A Slowly Changing Landscape. Nature Reviews Nephrology, 7, 96-109.

[10]   Uchida, K. and Nitta, K. (2012) Recent Advances in the Treatment of Lupus Nephritis. Clinical and Experimental Nephrology, 16, 202-213.

[11]   Airoldi, E.M. (2007) Getting Started in Probabilistic Graphical Models. PLOS Computational Biology, 3, e252.

[12]   Nishi, S., Ubara, Y., Utsunomiya, Y., Okada, K., Obata, Y., Kai, H., et al. (2016) Evidence-Based Clinical Practice Guidelines for Nephrotic Syndrome. Clinical and Experimental Nephrology, 20, 342-370.

[13]   Lee, K.J. and Carlin, J.B. (2010) Multiple Imputation for Missing Data: Fully Conditional Specification versus Multivariate Normal Imputation. American Journal of Epidemiology, 171, 624-632.

[14]   Churg, J. and Sobin, L. (1982) Renal Disease: Classification and Atlas of Glomerular Disease. Igaku-Shoin, Tokyo.

[15]   Hahn, B.H., McMahon, M.A., Wilkinson, A., Wallace, W.D., Daikh, D.I., Fitzgerald, J.D., et al., American College of Rheumatology (2012) American College of Rheumatology Guidelines for Screening, Treatment , and Management of Lupus Nephritis. Arthritis Care &Research (Hoboken), 64, 797-808.

[16]   Bono, L., Cameron, J.S. and Hicks, J.A. (1999) The Very Long-Term Prognosis and Complications of Lupus Nephritis and Its Treatment. QJM, 92, 211-218.

[17]   Levey, A.S., Lan, S.P., Corwin, H.L., Kasinath, B.S., Lachin, J., Neilson, E.G., et al. (1992) Progression and Remission of Renal Disease in the Lupus Nephritis Collaborative Study. Results of Treatment with Prednisone and Short-Term Oral Cyclophosphamide. Annals of Internal Medicine, 116, 114-123.

[18]   Fraenkel, L., MacKenzie, T., Joseph, L., Kashgarian, M., Hayslett, J.P. and Esdaile, J.M. (1994) Response to Treatment as a Predictor of Long-Term Outcome in Patients with Lupus Nephritis. The Journal of Rheumatology, 21, 2052-2057.

[19]   Austin, H.A., Boumpas, D.T., Vaughan, E.M. and Balow, J.E. (1994) Predicting Renal Outcomes in Severe Lupus Nephritis: Contributions of Clinical and Histologic Data. Kidney International, 45, 544-550.

[20]   Austin, H.A., Boumpas, D.T., Vaughan, E.M. and Balow, J.E. (1995) High-Risk Features of Lupus Nephritis: Importance of Race and Clinical and Histological Factors in 166 Patients. Nephrology, Dialysis, Transplantation, 10, 1620-1628.

[21]   Houssiau, F.A., Vasconcelos, C., D’Cruz, D., Sebastiani, G.D., de Ramon Garrido, E., Danieli, M.G., et al. (2004) Early Response to Immunosuppressive Therapy Predicts Good Renal Outcome in Lupus Nephritis: Lessons from Long-Term Followup of Patients in the Euro-Lupus Nephritis Trial. Arthritis & Rheumatology, 50, 3934-3940.