Introduction: Systemic lupus erythematosus is a multisystemic autoimmune disease characterized by various clinical manifestations, as well as unpredictable course and therapy response. Lupus nephritis is a severe manifestation of the disease, significantly influencing its prognosis. Since the pathogenesis of lupus nephritis has not been elucidated, optimal therapeutic approach is still subject of numerous studies.
Aim: A retrospective study was undertaken with the aim to analyze clinical features of different types of lupus nephritis, their therapy response as well as their course and outcome.
Patients and methods: The retrospective study included 67 patients who were regularly followed-up for 36-188 months after renal biopsy at the Department of Nephrology, Clinical Centre of Serbia or at the Department of Nephrology, Clinical Centre of Montenegro. Systemic lupus erythematosus was diagnosed according to the ARA criteria, while pathomorphological classification was based on WHO recommendations.
Results: The studied group was mostly composed of patients with proliferative lupus nephritis (21 with diffuse and 9 with focal) followed by 20 patients with membranous, 14 with mesangioproliferative (type IIb) and only one patient with type I, IIa and VI lupus nephritis each. Age distribution of the patients and incidence of extrarenal complications was equal in patient groups with different types of lupus nephritis. Only four patients were males. Choice of therapy depended on the morphological characteristics of lupus nephritis, presence and severity of extrarenal complications and renal function. At the time of analysis, 10/14 patients with lupus nephritis type IIb were in remission, as well as 14/30 type III/IV patients and 15/20 patients with type V lupus nephritis. The outcome was the worst in patients with proliferative lupus nephritis, and thus, at the time of analysis four of 30 patients had chronic renal failure, 7 were on regular haemodialysis, while 3 patients decreased. With respect to the renal function, the most favorable outcome was recorded in IIb patients, while mortality was not dependent on lupus nephritis type but on extrarenal manifestations of systemic lupus and associated diseases. Five- and ten-year patients' survival rates were 100% and 86%, respectively. Cardiovascular and cerebrovascular diseases were the most frequent causes of death.
Conclusion: Persistent and controlled treatment using a combination of different immunosuppressive drugs along with close follow-up of patients and possibility of dialysis treatment have significantly improved prognosis of patients with lupus nephritis, even in those with diffuse proliferative changes.