Abstract
The prognostic significance of mild proliferative lupus nephritis (focal or pure mesangial proliferation) has remained unclear because previous reports have failed to correlate changes on both light (LM) and electron (EM) microscopy with the clinical course. Twenty-one pts with SLE and a mild proliferative lesion on LM of the initial renal biopsy (RBx) were studied. In 11 cases either no electron dense deposits (6 pts) or deposits limited to the mesangial region alone (5 pts) were seen on EM. All 11 pts have had a good clinical outcome (mean followup 35 mo.) with normal BP and improved or normal renal function. Proteinuria increased in one pt to 0.6 Gm/d and in another pt to 5.0 Gm/d. A 2nd RBx in the latter pt revealed a membranous lesion with subepithelial deposits. In the remaining 10 pts abundant subendothelial electron dense deposits were present by EM on the initial RBx. Five of these pts have been stable or improved clinically (mean followup 30 mo.). However, the other 5 pts have all deteriorated clinically with increased proteinuria, reduced renal function, and significant HBP (mean followup 35 mo.). A second RBx in 4 of these pts revealed severe proliferative changes with persistence of subendothelial deposits. Three of these pts have died and one is on hemodialysis.
These data indicate 1) progression and clinical deterioration was seen only in pts with persistent subendothelial deposits; and 2) the location of electron dense deposits by EM was of greater significance than the degree of proliferation by LM.
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Domoto, D., Siegel, N. & Kashgarian, M. THE SIGNIFICANCE OF ELECTRON DENSE DEPOSITS IN MILD LUPUS NEPHRITIS. Pediatr Res 11, 549 (1977). https://doi.org/10.1203/00006450-197704000-01075
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DOI: https://doi.org/10.1203/00006450-197704000-01075