Clinical InvestigationMembranous (Class V) Renal Disease in Systemic Lupus Erythematosus May Be More Common Than Previously Reported: Results of a 6-Year Retrospective Analysis
Section snippets
METHODS
All renal biopsies were performed in patients with SLE at the University of Mississippi between January 1999 and December 2004 and retrospectively analyzed. Patients were included if they met ≥ 4 American College of Rheumatology criteria for SLE with evidence of kidney involvement. All renal biopsies tallied in this study had been earlier interpreted by the same renal pathologist. Results were validated by a detailed review of the original renal biopsy pathological reports (including electron
RESULTS
Ninety-two renal biopsies in patients with SLE were performed between January 1999 and December 2004. The majority of patients were African American (91.3%), with 5 whites and 3 of unknown race. Of 92 patients, 83.6% were women. The median age for patients with class V LN was 26 years, compared with class IV LN at 23 years. Class V pathology was the most common in our cohort (40.2%), followed by class IV at 36.9% (Table 2, Table 3).
The median serum creatinine level in the class IV LN group was
DISCUSSION
SLE is a multisystem disease that carries significant mortality and morbidity especially with regard to renal involvement. However, cumulative 5-year survival in LN has improved from < 50% in 1960s to > 80% in 1990s,11 possibly reflecting early implementation of more potent immunosuppressive therapies. It is also well established that there are considerable racial differences in the prevalence, severity, and prognosis of LN. Relatively, overall incidence of SLE is ~ 2 to 5 cases/100,000 persons
CONCLUSION
We analyzed 6 years of data from SLE kidney biopsies at a large, tertiary care center predominantly derived from African American population, and membranous lupus nephropathy was more common than previously reported. Interestingly, there were no sex differences in the prevalence of membranous lupus nephropathy in our biopsy cohort. It will be important that we continue to follow up this cohort over a long term to better understand the pathogenesis, clinical outcome, and management of MLN.
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