Class V membranous nephropathy in patients with systemic lupus erythematosus: Clinical characteristics, outcome and prognosis

IF 1 Q4 RHEUMATOLOGY

Egyptian Rheumatologist Pub Date : 2025-07-24 DOI:10.1016/j.ejr.2025.07.003

Nermeen Samy, Sherin H. Hamza, Fatma I. Mabrouk, Duaa F. Atyaallah, Mohammed M. Mohammed

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Abstract

Aim of the work

To study the clinical presentation, course, outcome and prognostic factors of membranous lupus nephritis (MLN) in systemic lupus erythematosus (SLE) patients.

Patients and methods

Ninty-six SLE patients with MLN were studied. The SLE disease activity index (SLEDAI) and SLE International Collaborating Clinics damage index (SLICC-DI) were assessed. 48 patients had pure MLN (Class V) and another 48 mixed (membranous plus proliferative classes III/IV) were recruited. The median follow-up was 24 months after the initial renal biopsy.

Results

Out of 96 patients, 86 were females and 10 were males with a mean age of 34.9 ± 10.6 years and disease duration of 8.85 ± 1.7 years. 43 (44.8 %) had nephrotic and 25 (26 %) nephritic syndrome.The mean SLICC-DI was 2.46 ± 1.2 while SLEDAI was 12.6 ± 4.3.76 (79.2 %) achieved complete remission, and 20 (20.8 %) partial remission. 4.2 % developed renal or extra-renal flare, 13.5 % had chronic kidney disease. Patients with mixed-type had a significantly higher SLEDAI (p < 0.0001), anti-double-stranded deoxyribonucleic acid (anti-dsDNA) titre (p = 0.028), serum creatinine (p = 0.016), chronicity index of renal biopsy (p = 0.001) and longer duration to achieve nephritis remission (p = 0.001) together with lower creatinine clearance (p = 0.009) in comparison with pure type. SLICC-DI > 3 (p = 0.002), SLEDAI > 14 (p < 0.001), Albumin/ Creatinine > 4.5 g/day (p = 0.013), serum creatinine > 1.36 mg/dl (p < 0.001), creatinine clearance < 84.3 mL/min (p = 0.002), urinary casts (p < 0.0001) and chronicity index > 6 (p = 0.003) were the main predictors of poor outcome among patients with MLN.

Conclusion

Mixed MLN had more severe clinical and histological presentations and a longer time to achieve complete and partial remission than the pure MLN.

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系统性红斑狼疮患者的V类膜性肾病：临床特征、结局和预后

目的探讨系统性红斑狼疮（SLE）患者膜性狼疮肾炎（MLN）的临床表现、病程、预后及影响预后的因素。患者与方法对96例合并MLN的SLE患者进行研究。评估SLE疾病活动性指数（SLEDAI）和SLE国际合作诊所损害指数（SLICC-DI）。48例单纯MLN （V类），另外48例混合性（膜性加增生性III/IV类）。中位随访时间为首次肾活检后24个月。结果96例患者中，女性86例，男性10例，平均年龄34.9±10.6岁，病程8.85±1.7年。43例（44.8%）有肾病，25例（26%）有肾病综合征。SLICC-DI平均为2.46±1.2，SLEDAI平均为12.6±4.3.76(79.2%)，部分缓解20（20.8%）。4.2%有肾脏或肾外耀斑，13.5%有慢性肾脏疾病。混合型患者SLEDAI显著高于对照组(p <；0.0001)、抗双链脱氧核酸（抗dsdna）滴度（p = 0.028）、血清肌酐（p = 0.016）、肾活检慢性指数（p = 0.001）、实现肾炎缓解所需时间更长（p = 0.001）、肌酐清除率较低（p = 0.009）。SLICC-DI祝辞3 (p = 0.002), SLEDAI >；14 (p <；0.001)，白蛋白/肌酐>；4.5 g/d (p = 0.013)，血清肌酐>；1.36 mg/dl；0.001)，肌酐清除率<；84.3 mL/min (p = 0.002)，尿模(p <；0.0001)和慢性指数>；6个（p = 0.003）是MLN患者预后不良的主要预测因子。结论与单纯MLN相比，混合型MLN具有更严重的临床和组织学表现，达到完全和部分缓解的时间更长。

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