신조직 검사로 입증된 루푸스 신염에 대한 치료 효과 및 예후 인자에 대한 후향적 연구

Abstract

Objectives : To evaluate the clinicopathologic character, therapeutic outcome, and prognostic factor of biopsy-proven lupus nephritis.

Methods : Biopsy proven lupus nephritis patients who were admitted at Yonsei Medical Center from January 1986 to Jung 1997 were included in this study. We retrospectively reviewed the medical records. Patients were treated with steroid regimen with or without cyclophosphamide. According to the therapeutic response, patients were divided into two groups: therapeutic response group and therapeutic nonresponse group.

Results : The results are as follows;

1. Among 68 biopsy-proven lupus nephritis cases, 54 patients who were treated at least 6 months were included in this stydy.

2. The mean follow up duration was 51 months. Mean serum creatinine was 1.4mg/dl, 24-hour proteinuria was 4,868mg, and anti-DNA antibody was positive in 76% at the time of renal biopsy.

3. Diffuse proliferative nephritis was the most common pathologic findings(32 cases, 59%). Activity index was highest in diffuse proliferative nephritis.

4. Overall 5-year renal survival rate was 25% and there was no difference between steroid single therapy and cyclophosphamide combination therapy. In diffuse proliferative nephritis, 5-year renal survival rate was 18% and there was no difference according to treatment.

5. Factor affecting therapeutic response was pathologic classification; diffuse proliferative nephritis was associated with poor therapeutic response(p=0.032).

6. Six patients(11%) progressed to end stage renal disease.

7. Major complications with treatment were infections including herpes zoster.

Conclusion : In our series of lupus nephritis, diffuse proliferative nephritis was poor prognostic factor.