Glomerular necrotic lesions and long-term outcomes among patients with proliferative lupus nephritis

Objectives: Although necrotic lesions are common in proliferative lupus nephritis (LN), little is known about the impact of these lesions on outcomes. This study was undertaken to investigate the impact of glomerular necrotic lesions on renal outcomes of doubling serum creatinine in patients with class III and IV LN and necrotic lesions. Methods: 52 patients with ISN/RPS class III or IV LN were enrolled in this retrospective study, with mean follow-up of 7.4 years. All patients underwent a repeat biopsy at 12-18 months after a baseline biopsy. Results: The prevalence of necrotizing lesions was observed in 24% of those with class III versus 70.4% with class IV (P = 0.001). The rate of no remission was 44% and 22.2% in those with and without necrosis (P = 0.007), respectively. The doubling of serum creatinine was observed in 32% of those with necrosis and in 14.8% with no necrosis (P = 0.01). The chronicity index in the repeat biopsy was significantly worse among those with necrosis. Conclusions: Glomerular necrosis identifies lupus nephritis patients at the greatest risk for progression to renal failure. Proactive intervention and possibly more aggressive induction therapies in patients with necrotizing lesions may protect the kidneys from developing chronic renal impairment.