Pastén V Rolando, Massardo V Loreto, Rosenberg G Helmar, Radrigán A Francisco, Roessler B Emilio, Valdivieso D Andrés, Jacobelli G Sergio
Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina de la Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Med Chil. 2005 Jan;133(1):23-32. doi: 10.4067/s0034-98872005000100004. Epub 2005 Mar 10.
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.
To study the clinical long-term outcome of WHO type V lupus membranous glomerulonephritis.
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.
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.
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.
世界卫生组织（WHO）V型狼疮性膜性肾小球肾炎的单纯形式的长期预后显然比其他形式的狼疮性肾小球肾炎更为良性。然而，此类患者中有12%会进展至终末期肾衰竭。蛋白尿的出现可能提示细胞毒性药物的使用。
研究WHO V型狼疮性膜性肾小球肾炎的临床长期预后。
对某大学病理科所有诊断为WHO V型狼疮性膜性肾小球肾炎的肾活检进行回顾性分析。查阅该病患者的病历，并对所有在世患者进行一次临床评估。
1973年至2000年期间，对系统性红斑狼疮患者进行了703次肾活检。其中，40例为膜性肾小球肾炎，33例患者（28名女性，年龄范围6 - 71岁）获得了病情演变和生存数据。19例为Va型，其余为Vb型肾炎。2例出现肾衰竭，11例蛋白尿超过3.5 g/24小时。自肾活检后的中位随访时间为63个月（范围1 - 316个月）。随访结束时，4例肌酐清除率低于15 ml/h，4例清除率在15至29 ml/h之间（其中1例接受了肾移植）。11例（33%）患者死亡，主要死于感染。肌酐清除率超过15 ml/h的患者五年生存率为75%。不良预后因素为活检时肌酐升高和高血压。
这些患者的临床结局不佳。12%进展至终末期肾衰竭阶段。这与静脉注射环磷酰胺治疗的增殖性肾小球肾炎进展至类似阶段的3%比例形成对比。必须寻找针对这种情况的新疗法。
