Lupus nephritis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S. [3]

Natural History, Complications and Prognosis

Natural History

Lupus nephritis may damage different parts of the kidney. Class I has normal histology and does not show any evidence of disease and class V shows an extensive disease.

Complications

Possible complications include:

• Interstitial nephritis
• Nephrotic syndrome
• Membranous glomerulonephritis
• Kidney failure - acute and chronic
• End stage renal disease

Prognosis

• The class of lupus nephritis: Focal lupus nephritis, minimal mesangial lupus nephritis and mesangial proliferative lupus nephritis have better prognosis than other classes. And, advanced sclerosis lupus nephritis carries a poor prognosis.
• Nephrotic syndrome carries worse prognosis.
• Creatinine level: Patients with elevated creatinine (>3 mg/dL) at presentation have worse outcomes.
• Patients with persistently elevated anti-dsDNA and low C3 and C4 levels have poorer outcomes.
• Renal biopsy findings showing diffuse lupus nephritis or high chronicity index suggest worse prognosis.
• Young age onset carries worse prognosis.
• Male gender have poorer outcomes than female.
• Black race have worse outcomes than other races.
• Although lupus nephritis may return in a transplanted kidney, it rarely leads to end-stage kidney disease.