Reyhan KÖSE ÇOBANOĞLU, Utku ŞENTOSUN, Hasan BAYINDIR, Gökhan SARGIN
Journal of Experimental and Clinical Medicine - 2026;43(2):183-190
Lupus nephritis (LN) is classified histopathologically according to the 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification. We aimed to compare characteristics and renal outcomes across histological classes of LN, with particular emphasis on class I/II disease. We conducted a retrospective cohort study of patients with biopsy-proven LN. Patients were categorized into three groups: class I/II, class V or mixed class II/V, and proliferative class III/IV(+/-V). Baseline demographic, clinical, and serological characteristics and short-term renal outcomes [12-month complete renal response (CRR), partial renal response (PRR), and inadequate renal response (IRR)] were compared between groups. Long-term outcomes [chronic kidney disease (CKD) or end-stage renal disease (ESRD)] were assessed with survival analyses. A total of 82 patients were included: 13 with class I/II, 15 with class V or mixed class II/V, and 54 with proliferative class III/IV(+/-V) LN. Baseline proteinuria and serum creatinine levels were significantly higher, whereas the estimated glomerular filtration rate (eGFR) was significantly lower, in patients with proliferative disease (all p<0.05). Most demographic, clinical, and serological features were otherwise comparable, except for anti-centromere B positivity, observed only in the class I/II group (27%, p=0.004). Rates of renal responses at 12 months were similar across groups (p=0.766). During a mean follow-up of 158 months, 18 patients (22%) developed CKD or ESRD. Ten-year CKD/ESRD-free survival was 82% in both class I/II and in class V or II/V and was 77% in class III/IV(+/-V) LN, respectively, without significant differences between groups (log-rank p=0.371). Patients achieving CRR or PRR showed a trend toward better renal survival compared with non-responders (log-rank p=0.065). These findings underscore the clinical heterogeneity across LN classes and the need for individualized management beyond histopathology, while the long-term prognosis of class I/II LN remains to be clarified in prospective studies.
