Systemic lupus erythematosusMembranous Nephropathy in Systemic Lupus Erythematosus: Long-Term Outcome and Prognostic Factors of 103 Patients
Section snippets
Methods
One hundred three patients with biopsy-proven LMN were diagnosed and followed in 2 Italian renal units (Ospedale Maggiore, Ospedale San Carlo in Milan) from January 1974 to December 2008. Of them, 67 had pure membranous nephritis (class V) and 36 mixed LMN (18 class V+III, 18 class V+IV). The clinical characteristics at presentation of this cohort are reported in Table 1. Six patients were lost to follow-up within a few months after renal biopsy, all with pure LMN. The mean follow-up of the
Comparison Between Proliferative and Nonproliferative Membranous Lupus Nephritis
We compared the clinical and histological characteristics at presentation and the treatment and the outcome of patients with pure LMN with those of with mixed LMN.
In Table 1, the demographic and clinical characteristics at presentation of the 2 groups are compared. Patients with mixed LMN had a higher frequency of nephrotic syndrome, low C3 and C4, anti-DNA positivity, and a tendency toward a lower creatinine clearance. Moreover, mixed LMN had a higher activity and chronicity index.
Discussion
In this retrospective study, we report on a large cohort of LMN followed for a mean period of 13 years, 1 of the longest follow-ups reported until now to the best of our knowledge. Patients have been divided into pure LMN and mixed LMN with the aim of comparing their clinic presentation, course, and long-term outcome.
To the more severe histological picture of mixed LMN in terms of activity and chronicity index, corresponds a more severe clinical presentation than in patients with pure LMN;
Acknowledgments
We would like to thank Alessia and Andrea Centa and Marina Balderacchi for their secretarial assistance.
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Membranous Lupus Nephritis: A Clinical Review
2019, Advances in Chronic Kidney DiseaseCitation Excerpt :In addition, it is also widely believed that the presence of an accompanying proliferative lesion is associated with worse renal outcomes.6,56,87 However, the evidence is not clear as other cohort studies report no differences in patient or renal survival in patients with mixed vs pure MLN after long-term follow-up.57,88 One of the caveats of studying the long-term outcome of patients with MLN is that it is one of the lesions that is prone to class switch, with multiple studies demonstrating a change from an MLN to a proliferative LN or a mixed lesion on repeat biopsy in 25%-100% of patients,89-92 especially in patients with persistent proteinuria and worsening kidney function.90
Effect of complete or partial proteinuria recovery on long-term outcomes of lupus nephritis
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2018, Autoimmunity ReviewsMembranous Lupus Nephritis: The Same, But Different
2016, American Journal of Kidney DiseasesCitation Excerpt :However, severe hypoalbuminemia is clearly linked to increased thrombotic risk, particularly in primary membranous nephropathy, and patients with serum albumin levels < 2.8 g/dL should be considered for prophylactic anticoagulation, depending on the individual bleeding risk.25,26 Antiphospholipid antibodies are associated with a higher incidence of arterial and/or venous thrombosis in patients with SLE, particularly lupus anticoagulant and IgG β2-glycoprotein 1 antibodies.27,28 The coexistence of antiphospholipid antibodies and hypoalbuminemia is likely to increase the risk for thromboembolic disease and lower the threshold for initiating anticoagulation.
Pure Membranous Lupus Nephritis: Description of a Cohort of 150 Patients and Review of the Literature
2019, Reumatologia ClinicaCitation Excerpt :Research on MLN frequency, natural history, prognosis and treatment was further limited due to a lack of uniform definition over the past several decades, making it difficult to get consistent information from the published literature about MLN.1 An Italian study15 has reported the outcome in 103 patients with MLN, but a third of them had mixed forms. More recently, Mejía-Vilet et al.13 have reported the results of a cohort of 60 Hispanic and Mexican-mestizo patients with pure MLN suggesting an impact of ethnicity on the response to different immunosuppressants (azathioprine, cyclophosphamide or mycophenolate).
Present address of Beniamina Gallelli, MD, Divisione di Nefrologia e Dialisi, Azienda Ospedaliera Sant'Anna, Como, Italy.