Avaliação das diferenças clínicas, histopatológicas e no prognóstico renal de pacientes com nefrite lúpica classe IV segmentar e global

The International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification of lupus nephritis (LN) divided class IV into segmental and global (IV-S and IV-G), based on evidence suggesting worse renal outcomes in patients with segmental lesions. However, others subsequent studies failed to detect significant differences and showed a trend toward higher risk of end stage renal disease (ESRD) and doubling of serum creatinine in LN IV-G. This retrospective analysis as performed to evaluate the differences in clinicopathological characteristics and renal outcomes between these two subclasses. Retrospective cohort study of adult patients with diagnosis of systemic lupus erythematosus and biopsy proven LN class IV using ISN/RPS classification. Clinical characteristics, pathological data and long-term follow-up were analyzed. Primary end point was ESRD. Secondary end points were treatment response and doubling serum creatinine (sCr). We evaluated 89 patients, 34 patients with class IV-S and 55 patients with class IV-G. There were no differences in age, gender and race among the groups. The rate of hypertension was significantly higher in IV-G group (89% vs. 65%, p=0.006). Rapidly progressive glomerulonephritis was 2 times more frequent in IV-G group (60% vs 29% p=0.005). The risk of renal replacement therapy at baseline was 4.3 times greater in IV-G group than in IV-S group (95% CI 1.1-17.9; p=0.019). LN IV-G group had a higher rate of patients with crescents (70.1% vs. 57.1%; p=0.002) and more biopsies with crescents in ≥ 50% of glomeruli (34.5% vs. 5.8%; p=0.007). After a mean follow-up of 57.2 ± 37.4 months, the IV-S group had greater estimated glomerular filtration rate (79.7 vs 56.0ml/min/1.73m², p=0.009) and a higher rate of complete remission than the IV-G group (58.8% vs 32.7%, p=0.016). Patients with class IV-G had significantly greater probability of doubling sCr (58.2% vs 20.6%; p=0.001) and ESRD (34.5% vs 8.8%, p=0.006) than patients with class IV-S. Patients with class IV-G had more severe clinicopathological presentation and higher risk of doubling sCr and ESRD compared to patients with class IV-S.