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Remission of proteinuria under therapeutic intervention and the renal outcomes in Japanese patients with lupus nephritis class III and IV.

Modern Rheumatology 2018 December 18
BACKGROUND: Recent studies have identified the significance of proteinuria levels after initial induction therapies on the renal outcomes in patients with proliferative lupus nephritis, but the issue has not been evaluated in Japanese patients.

METHODS: Based on the ISN/RPS classification, only patients diagnosed as lupus nephritis class III or IV were included. The remission of proteinuria twelve months after diagnosis, as well as the clinicopathological features at diagnosis, on renal outcomes was examined retrospectively. Renal progression was defined as a 50% decrease in the estimated glomerular filtration rate or the development of end-stage renal disease.

RESULTS: This study included the eighty-two Japanese patients, with a median follow-up period of seven years. Although all patients received intensive induction therapy, fifteen patients (18%) showed progression. Proteinuric remission twelve months after diagnosis predicted a good renal outcome by multivariate analysis. A receiver-operating characteristic analysis of the 38 patients whose quantitative urinary protein excretion levels at twelve months were available for analysis showed that a cut-off value of 0.8 g/day predicted renal progression most effectively. Neither the renal function nor proteinuria level at diagnosis was associated with the renal outcomes.

CONCLUSIONS: In Japanese patients with lupus nephritis class III or IV, proteinuria levels after twelve months under intensive therapy predicted renal outcomes more accurately than did factors identified at diagnosis. (216 words).

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