SYSTEMIC LUPUS WITH NEPHRITIS - LONG-TERM STUDY

Abstract

Patients [71] with systemic lupus erythematosus and clinical evidence of nephritis were seen during a 15 yr period, and followed for a mean of 7 yr. Survival was calculated to be 76% at 5 yr and 57% at 10 yr from the onset of clinical nephritis; and 80, 65, 55 and 55% 5, 10, 15 and 20 yr from onset of clinical lupus. Renal biopsies showed mild or focal lesions in 30% of patients, membranous lesions in 14% and diffuse proliferative lesions in 55%. There was no difference in the long-term outcome of the different histological groups. Nineteen patients (27%) died during follow up, 11 from renal failure, 6 from sepsis and 2 from cerebral lupus. Death in renal failure is now usually a late event in lupus, even in patients with clinical evidence of severe nephritis. The prognosis of even severe lupus nephritis is now better than formerly reported. Reducing the dose of corticosteroid drugs, by the use of cytotoxic drugs such as azathioprine may have diminished the mortality from cardiovascular complications. Side effects of treatment remain an important cause of death and morbidity.