The prognosis of segmental glomerulonephritis in systemic lupus erythematosus

The prognosis of segmental glomerulonephritis in systemic lupus erythematosus. Severe segmental glomerulonephritis (Seg GN) (≥ 50% involverhent) in systemic lupus erythematosus (SLE) is classified as diffuse GN (DPGN) in the WHO classification. We tested the validity of the assumption that severe Seg GN and DPGN have the same prognosis by determining the proportion of glomeruli involved by active segmental inflammation in a series of 127 patients and by comparing the prognosis in various categories of Seg GN with patients with DPGN. In Seg GN we found mild involvement (1 to 19%) in 19 patients, moderate involvement (20 to 49%) in 9 patients and severe involvement (≥ 50%) in 17 patients. There were 28 cases of DPGN. The actuarial five-year survival of patients with mild and moderate Seg GN was 82%. The survival of patients with severe Seg GN and DPGN were 59 and 53%, respectively. The incidence of adverse outcomes, including death, end–stage kidney disease, and deterioration of renal function was similar in patients with severe Seg GN and DPGN, and greater than in patients with mild and moderate Seg GN. Although there was a trend associating increasing glomerular involvement with elevated urinary protein excretion and serum creatinine and decreased serum C3 and C4, the differences were not significant. Cumulative prednisone dose and prednisone given in the first and second years following biopsy were not different in the various categories of Seg GN and DPGN, suggesting that differences in outcome were not related to the amount of prednisone therapy. We conclude that the prognosis in SLE Seg GN is a function of the proportionality of glomerular involvement, and in severe Seg GN the five year survival and clinical outcome is similar to that of DPGN. In SLE GN involvement of 50% or more of the glomeruli in a renal biopsy by active segmental lesions identifies a group of patients with a poor prognosis