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Value of a Complete or Partial Remission in Severe Lupus Nephritis

Yiann E. Chen^*, Stephen M. Korbet^*, Robert S. Katz^*, Melvin M. Schwartz, Edmund J. Lewis^*; for the Collaborative Study Group

Departments of ^* Medicine and Pathology, Rush University Medical Center, Chicago, Illinois

Correspondence: Dr. Stephen M. Korbet, Section of Nephrology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612. Phone: 312-850-8434; Fax: 312-850-8431; E-mail: skorbet{at}aol.com

Background and objectives: The value of a complete remission in severe lupus nephritis is well known but little is known about the impact of a partial remission in this patient population. The purpose of this study was to evaluate the long-term prognosis of achieving a complete or partial remission in a well-defined group of patients with severe lupus nephritis.

Design, setting, participants, & measurements: In this study, 86 patients with diffuse lupus glomerulonephritis were reviewed for assessment of the value of a partial remission (50% reduction in baseline proteinuria to 1.5 g/d and 25% increase in baseline creatinine) and complete remission (proteinuria 0.33 g/d and serum creatinine 1.4 mg/dl) on outcomes compared with patients who did not attain a remission. These well-characterized patients were entered into a prospective therapeutic trial conducted by the Collaborative Study Group and were followed for more than 10 yr.

Results: All biopsies showed diffuse lupus nephritis. A complete remission was attained in 37 (43%) patients, a partial remission in 21 (24%) patients, and no remission in 28 (32%) patients. Baseline clinical and serologic features were similar among the groups, but patients with a complete remission had a lower serum creatinine and chronicity index compared with patients with partial or no remission. The patient survival at 10 yr was 95% for complete remission, 76% for partial remission, and 46% for no remission. The renal survival at 10 yr was 94% for complete remission, 45% for partial remission, and 19% for no remission, and the patient survival without end-stage renal disease at 10 yr was 92% for complete remission, 43% for partial remission, and 13% for no remission.

Conclusion: Even a partial remission in lupus nephritis is associated with a significantly better patient and renal survival compared with no remission.

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