Ponticelli C, Zucchelli P, Moroni G, Cagnoli L, Banfi G, Pasquali S
Division of Nephrology and Dialysis, Hospital Maggiore Policlinico, Milano, Italy.
Clin Nephrol. 1987 Dec;28(6):263-71.
The follow-up of 43 patients with diffuse proliferative lupus nephritis is reported. After histological diagnosis, all patients were treated with 3 intravenous high-dose methylprednisolone pulses and then with low-dose oral steroids and 31 with cytotoxic drugs. Renal and extra-renal exacerbations were also treated with intravenous high-dose steroids. Patients were followed for 1 to 13 years. At 10 years the patient survival rate was 87% and the kidney survival rate was 79%. If 3 extra-renal deaths are excluded, the actuarial 10-year kidney survival rate is 91%. At present, 21 patients do not show any renal abnormalities, 13 patients have normal plasma creatinine but proteinuria, 3 patients have stable renal function impairment, 2 patients have worsening of their renal function, 1 is on regular dialysis. The other 3 patients died (from cardiac failure, cerebral hemorrhage and a car accident). The incidence of flare-ups was low (0.1 episodes per year). Severe side effects were rare in this series. It is concluded that the long-term prognosis of diffuse lupus nephritis is becoming considerably better. Therapy based on a short course of intravenous high-dose methylprednisolone and on a maintenance regimen with low doses of steroid and cytotoxic agents can contribute to preserving renal function while avoiding severe side effects.
本文报告了43例弥漫性增殖性狼疮性肾炎患者的随访情况。经组织学诊断后，所有患者均接受了3次静脉注射大剂量甲基泼尼松龙冲击治疗，随后接受小剂量口服类固醇治疗，31例患者还接受了细胞毒性药物治疗。肾内和肾外病情加重时也采用静脉注射大剂量类固醇治疗。对患者进行了1至13年的随访。10年时患者生存率为87%，肾脏生存率为79%。如果排除3例肾外死亡病例，10年肾脏精算生存率为91%。目前，21例患者未出现任何肾脏异常，13例患者血浆肌酐正常但有蛋白尿，3例患者肾功能损害稳定，2例患者肾功能恶化，1例患者定期透析。另外3例患者死亡（分别死于心力衰竭、脑出血和车祸）。病情复发率较低（每年0.1次发作）。本系列中严重副作用罕见。结论是弥漫性狼疮性肾炎的长期预后正显著改善。基于短期静脉注射大剂量甲基泼尼松龙以及小剂量类固醇和细胞毒性药物维持治疗方案有助于保护肾功能，同时避免严重副作用。
