THE PROGNOSTIC MARKERS, CURRENT TREATMENT STRATEGIES AND THE LONG TERM PROGNOSIS FOR PROLIFERATIVE FORMS OF LUPUS NEPHRITIS

Renal manifestations of systemic lupus erytematosus (SLE) are highly variable in clinical presentation, ranging from mild asymptomatic proteinuria to rapidly progressive glomerulonephritis leading to end stage renal disease.Renal biopsy evaluated by light microscopy, immunofluorescence and electron microscopy where possible, provides invaluable information for the proper histopathological classification and for assessing the disease activity and chronicity. The World Health Organization (WHO) classification of lupus nephritis is a practical and widely accepted system for categorizing the main renal lesions observed on biopsies of patients with lupus nephritis(Table I) (1). The focal and diffuse proliferative forms of lupus nephritis corresponding to WHO class III and IV have the worst prognosis, leading to ESRD in 20-30% of the cases (2). A substantial proportion of patients with class III nephritis progress to class IV disease and it has been suggested that these two classes are qualitatively similar and simply reflect milder or more severe stages respectively (3).The aim of this article is to overview the prognostic markers, the current treatment strategies and the long term prognosis for the latter forms of lupus nephritis.

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