Outcome and Prognostic Factors of Class V Membranous Nephropathy (Pure and Mixed Form) in a Cohort of Egyptian Patients with Systemic Lupus Erythematosus

Abstract Background Renal disease is a frequent and severe cause of morbidity in systemic lupus erythematosus (SLE). Lupus membranous nephropathy (LMN), which is an uncommon subtype of lupus nephritis, is usually associated with nephrotic syndrome and can have a variable course; some patients maintain stable kidney function or show a slow progression, while others can have renal flares and transformation to more severe proliferative forms eventually leading to ESRD or to life-threatening extrarenal complications, including thrombotic events, cardiovascular disease (CVD), or infections. In many cases, a combination of membranous and proliferative lesions may be seen in renal biopsies. Objective To study the clinical presentation, course, outcome and prognostic factors of class V membranous nephropathy (pure and mixed) in a cohort of Egyptian patients with SLE. Methods This was an observational study which was conducted on ninety six (96) adult Egyptian patients diagnosed with LMN recruited from the outpatient clinic and inpatient department of rheumatology, at Ain Shams university hospitals, during a period of 12 months. Results In this study, the univariate logistic regression analysis shows that (low level of WBCs, low level of hemoglobin, high level creatinne, high level of urine, Protein / Cr ratio, low level of Creatinine clearance) were found significantly associated with poor outcome in patients with mixed type. Also, the multivariate logistic regression analysis shows that the most important factors associated with poor outcome in patients with mixed type was found WBCs level ≤3. WBC of urine analysis>10, that ESR >28, partial remission and SLEDAI score >13 were found significantly associated with poor outcome among patients with pure MLN. Also, the multivariate logistic regression analysis shows that the most important factor associated with poor outcome in patients with pure type was found partial remission. Conclusion The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes and longer follow up to reassess our findings.