Clinical Outcomes of Patients with Biopsy-proven Lupus Nephritis in NUH

HC Gan, KH Yoon, KY Fong
Correspondence: Dr Gan Hwa Chau, ganhwachau@yahoo.com

ABSTRACT
Objective To review the clinical outcomes of Systemic Lupus Erythematosus (SLE) patients with biopsy-proven lupus nephritis with regards to the histological features and treatment.
Method Patients (1) with SLE, (2) had renal biopsy in NUH for lupus nephritis, and (3) on follow-up from the period of January 1998 to April 2001, were reviewed.
Result Fifty patients were reviewed with female to male ratio of 4:1. Mean age was 35.4 years. Sixty-eight percent had renal involvement at diagnosis of SLE. At least 50% had other major organ systems involvement. Forty-two patients had WHO Class IV lupus nephritis. Biopsy showed crescents in 17 patients, microangiopathy in 19, and vasculitis in two patients. All patients received prednisolone. Forty-one had IV cyclophosphamide, two had oral cyclophosphamide and seven had cyclosporin A. Azathioprine was used in 41 patients, pulse methylprednisolone in eight, IVIG in four, plasma exchange in three and mycophenolate in two patients.
Outcome Forty-four percent were in complete remission, 26% in partial remission, 34% had relapsed nephritis, 4% had chronic renal failure and 12% progressed to ESRD. There were five deaths.
Conclusion Renal involvement in SLE occurs early in the disease and is associated with other organ systems involvement. Only 44% were in complete remission. Thirty-four percent had relapsed. Renal survival was 88% in this cohort.

Keywords: lupus nephritis, treatment, outcome
Singapore Med J 2002; 43(12): 614-616