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Long-term renal outcomes of mesangial proliferative lupus nephritis in Chinese patients

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Abstract

Objective

This study aimed to explore the long-term outcomes of mesangial proliferative lupus nephritis (LN class II) and the factors associated with its relapse and histological transformation in Chinese patients.

Methods

104 SLE patients with biopsy-proven LN class II were included and divided into proteinuria group (proteinuria ≥ 0.4 g/24 h, with or without microscopic hematuria) and hematuria group (microscopic hematuria with proteinuria < 0.4 g/24 h).Patients were treated with glucocorticoid alone (GC monotherapy) or GC in combination with other immunosuppressant (combination therapy). The rates of remission, relapse, histological transformation, end-stage renal disease (ESRD), adverse events, and risk factors related to the outcomes were analyzed.

Results

During the median follow-up of 77.5 (IQR 58–116.5) months, all the 104 patients achieved remission. Relapse occurred in 69 cases (66.3%), of which 37 were of renal relapse (35.6%). Histological transformation was found in 14 of the 16 (87.5%) cases who received repeated renal biopsy after renal relapse. At the end of follow-up, 3 (2.9%) patients developed ESRD. There were no significant differences in the rates of relapse, histological transformation, adverse events and in the time from remission to relapse between the proteinuria group and the hematuria group. In contrast, the cumulative relapse rate in the GC monotherapy group was much higher than that in the combination group (P < 0.01). Adverse events occurred in 55 (57.3%) patients during follow-up.

Conclusions

Patients with LN class II have high rates of relapse and renal histological transformation and need optimal maintenance therapy.

Key Points

• The rates of relapse and histological transformation are high in patients with LN class II.

• Patients with LN class II are suggested to receive combination therapy and consider repeat renal biopsy after renal relapse.

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Acknowledgements

None.

Funding

This study was supported by the National Natural Science Foundation of China (81770701).

Author information

Authors and Affiliations

  1. National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210016, Jiangsu, China

    Shaofan Wang, Duqun Chen, Ke Zuo, Feng Xu & Weixin Hu

  2. The First School of Clinical Medicine, Southern Medical University, Nanjing, China

    Weixin Hu

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  1. Shaofan Wang
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  2. Duqun Chen
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  3. Ke Zuo
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  4. Feng Xu
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  5. Weixin Hu
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Contributions

SW designed the study, collected and analyzed data, and wrote the manuscript. DC and KZ helped in gathering the clinical information and analysing the data. FX evaluated renal histopathology. WH designed, organized the study and revised the manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Weixin Hu.

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Ethics approval

The study was performed according to the 1997 Declaration of Helsinki of the World Medical Association and was approved by the ethics committee of Jinling Hospital(2019NZKYKS-003–01). Given that the study was based on the review of medical records, written informed consent was therefore waived.

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Wang, S., Chen, D., Zuo, K. et al. Long-term renal outcomes of mesangial proliferative lupus nephritis in Chinese patients. Clin Rheumatol 41, 429–436 (2022). https://doi.org/10.1007/s10067-021-05909-y

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  • DOI: https://doi.org/10.1007/s10067-021-05909-y

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