Moroni Gabriella, Quaglini Silvana, Gallelli Beniamina, Banfi Giovanni, Messa Piergiorgio, Ponticelli Claudio
Unita' Operativa di Nefrologia e Dialisi, Fondazione Ospedale Maggiore Policlinco, Mangiagalli, Regina Elena IRCCS, Via F. Sforza, Milano, and Dipartimento di Informatica e Sistemistica, Universita' degli Studi di Pavia, Italy.
Nephrol Dial Transplant. 2007 Sep;22(9):2531-9. doi: 10.1093/ndt/gfm245. Epub 2007 May 17.
Few data are available about the very long-term outcome of patients with proliferative lupus nephritis.
Ninety-three Italian patients with biopsy-proven proliferative lupus nephritis (15 with class III, 9 with class III+V, 64 with class IV and 5 with class IV+V) followed for a median follow-up of 15 years in a single renal unit were considered for this observational study. Patients were treated with an induction treatment consisting of high doses of corticosteroids plus immunosuppressive agents in the more severe cases. This treatment was repeated in the event of a renal flare. Then corticosteroids and immunosuppressive agents were reduced to the minimal effective dose for maintenance.
Renal survival including death was 97% at 10 years and 82% at 20 years. At the last follow-up visit, 59 patients were in complete renal remission, 18 were in partial renal remission, four patients had chronic renal insufficiency, six had entered end-stage renal disease and six patients had died. At multivariate analysis the lack of achievement of complete renal remission and the occurrence of nephritic flares were significantly correlated both with the risk of doubling plasma creatinine and death or dialysis. Those patients who entered complete renal remission had significantly less probability of developing nephritic flares.
The long-term prognosis of Caucasian patients with proliferative lupus nephritis may be better than usually thought. Favorable factors for good long-term outcome are the achievement of complete renal remission, the absence of nephritic flares and their complete reversibility after therapy.
关于增殖性狼疮性肾炎患者的极长期预后的数据很少。
本观察性研究纳入了93例经活检证实为增殖性狼疮性肾炎的意大利患者（15例为III级，9例为III + V级，64例为IV级，5例为IV + V级），这些患者在单个肾脏科室进行了中位随访15年。在病情较重的情况下，患者接受了由高剂量皮质类固醇加免疫抑制剂组成的诱导治疗。如果出现肾脏活动复发，则重复该治疗。然后将皮质类固醇和免疫抑制剂减至维持所需的最小有效剂量。
包括死亡在内的肾脏生存率在10年时为97%，在20年时为82%。在最后一次随访时，59例患者完全肾脏缓解，18例部分肾脏缓解，4例患者有慢性肾功能不全，6例进入终末期肾病，6例患者死亡。多变量分析显示，未实现完全肾脏缓解和出现肾炎活动复发均与血肌酐翻倍、死亡或透析风险显著相关。那些进入完全肾脏缓解的患者发生肾炎活动复发的可能性明显较小。
白种人增殖性狼疮性肾炎患者的长期预后可能比通常认为的要好。长期预后良好的有利因素是实现完全肾脏缓解、无肾炎活动复发以及治疗后完全可逆。
