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Predictive value of clinical, laboratory, pathologic, and treatment variables in steroid/lmmunosuppressive resistant lupus nephritis
Author(s) -
Wallace Daniel J.,
Goldfinger Dennis,
Savage Gail,
Nichols Sherri,
Goodman David,
Fichman Marshal,
Stewart Morgan,
Klinenberg James R.
Publication year - 1988
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.2920040107
Subject(s) - medicine , lupus nephritis , plasmapheresis , creatinine , gastroenterology , biopsy , systemic lupus erythematosus , population , renal biopsy , immunology , disease , antibody , environmental health
Abstract Twenty‐seven patients with lupus nephritis and nephrotic syndrome had persistent disease activity despite an adequate trial of corticosteroids and immunosuppressive drugs; 30% were Asians, compared with 7% of our overall SLE population. Two years later, seven had a very good outcome and seven a poor outcome. Thirty clinical, pathological, laboratory, and treatment variables were analyzed in a good versus poor responder subset comparison in an effort to determine which factors were associated with favorable outcome. Administration of pulse steroids (P = .069) and a low biopsy chronicity index (P = .048) were associated with the good responder subset. Serum creatinine, biopsy class, blood pressure, complement, and anti‐DNA values at entry as well as the choice of immunosuppressive drug were not helpful in predicting outcome. All seven good responders were plasmapheresed (P = .026). Patients with refractory lupus nephritis who have a low biopsy chronicity index may benefit from the use of pulse steroids or plasmapheresis, and controlled studies are suggested.