Korean Journal of Nephrology 1987;6(1):73-82.

낭창성 신염 환자에서 신부전증 진행 예측지표에 관한 연구

박시훈 , 한대석 , 이호영 , 김문재 , 구철희 , 정현주 , 최인준

Abstract

Because of the morbidity and mortality associated with lupus nephritis and its therapy, investigators in a number of centers have tried to improve the understand- ing of its prognostic indicators. So that, we have studied retrospectively on the prog- nostic indicators predictive of chronic renal failure in lupus nephritis patients followed at Severance Hospital. The results obtained in this study were as follows: 1) Among clinicolaboratory findings (age, sex, hematuria, 24 hours urine protein, serum creatinine, ESR, ANA, anti-DNA, C, C,) and renal pathological findings (WHO classification, activity index, chronicity index), 24 hours urine protein, serum creatinine, WHO classification, activity index and chronicity index were signicant indicators predictive of chronic renal failure in lupus nephritis. Especially chronicty index was the most significant indicator. 2) Among 29 patients with lupus nephritis, 4 patients had progressed to chronic renal failure during the obser- vation period. The activity index and chronicity index of these 4 patients at the time of biopsy were over 8 and 3, respectively. 3) The rate of changes of serum creatinine level over time was significantly high in lupus nephritis patients with chronicity index more than 3 at the time of renal biopsy. Activity index score was less significant as prognostic indicator. 4) In patients with diffuse proliferative lupus nephri- tis, chronicity index scores showed wide spread varia- tion. However, progression to chronic renal failure was observed only in those patients with chronicity index more than 3, implying augumented prognostic informa- tions by considering chronicity index scores besides of WHO classification. 5) Cox hazard model analysis of predictive probabil- ity of progression to chronic renal failure revealed significant correlation with chronicity index score more than 3 at the time of biopsy. In conclusion, it is suggested that chronicity index of renal pathologic changes can augument prognostic in- formation derived from WHO classification.