Clinical kidney journal · 2026
Long-term kidney and patient outcomes in pure versus mixed lupus membranous nephritis.
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Uzzo Martina, Bracalenti Marisol, Calatroni Marta, Trezzi Barbara, Conte Emanuele, Locatelli Laura, Gatto Mariele, Depascale Roberto, Rossi Giovanni Maria, Limperio Vincenzo, Sinico Renato Alberto, Doria Andrea, Moroni Gabriella Luisa
Аннотация
OBJECTIVE: Pure membranous lupus nephritis [pMLN, Class V International Society of Nephrology/Renal Pathology Society (ISN/RPS)] is traditionally considered less aggressive than mixed forms of MLN (mMLN, Classes III/IV ± V ISN/RPS). Only two trials have compared the outcome of these two forms of MLN, with inconclusive results. In this retrospective multicentre study, we assessed and compared the short and long-term outcomes of pMLN versus mMLN.
METHODS: Patients diagnosed with pMLN or mMLN on their first kidney biopsy were included. The main outcomes were complete renal response after 1 year, sustained complete response, relapse rates, chronic kidney disease (CKD)-free survival, and the composite outcome of kidney failure (KF)/death-free survival.
RESULTS: Of the 195 patients included, 96 (49.2%) pMLN had milder immunological features of active LN at baseline compared to 99 (50.8%) with mMLN. At kidney biopsy, the National Institute of Health activity and chronicity indices were lower in patients with pMLN (P < .001). Moreover, they received less intensive immunosuppressive treatment (less i.v.-steroids, lower use/earlier withdrawal of the immunosuppressive regimen). Both groups achieved similar rates of responses, relapses, and kidney survival over follow-up.KF/death-free survival was significantly lower in pMLN compared to mMLN (P = .026). In a Cox-model adjusted for baseline kidney function and induction immunosuppressive regimen, mMLN retained an 80% lower risk of KF/death compared to pMLN (P = .0384). In a subgroup analysis, crude survival differences between pMLN and mMLN were confirmed only in patients biopsied before 2000.
CONCLUSION: This study challenges the long-standing view of pMLN as a generally benign condition, suggesting that less intensive treatment of pure MLN may have contributed to less favourable hard outcomes in the long-term.
METHODS: Patients diagnosed with pMLN or mMLN on their first kidney biopsy were included. The main outcomes were complete renal response after 1 year, sustained complete response, relapse rates, chronic kidney disease (CKD)-free survival, and the composite outcome of kidney failure (KF)/death-free survival.
RESULTS: Of the 195 patients included, 96 (49.2%) pMLN had milder immunological features of active LN at baseline compared to 99 (50.8%) with mMLN. At kidney biopsy, the National Institute of Health activity and chronicity indices were lower in patients with pMLN (P < .001). Moreover, they received less intensive immunosuppressive treatment (less i.v.-steroids, lower use/earlier withdrawal of the immunosuppressive regimen). Both groups achieved similar rates of responses, relapses, and kidney survival over follow-up.KF/death-free survival was significantly lower in pMLN compared to mMLN (P = .026). In a Cox-model adjusted for baseline kidney function and induction immunosuppressive regimen, mMLN retained an 80% lower risk of KF/death compared to pMLN (P = .0384). In a subgroup analysis, crude survival differences between pMLN and mMLN were confirmed only in patients biopsied before 2000.
CONCLUSION: This study challenges the long-standing view of pMLN as a generally benign condition, suggesting that less intensive treatment of pure MLN may have contributed to less favourable hard outcomes in the long-term.