Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1998 Apr;57(4):226–230. doi: 10.1136/ard.57.4.226

Renal haemodynamic characteristics in patients with lupus nephritis

M Nakano 1, M Ueno 1, H Hasegawa 1, T Watanabe 1, T Kuroda 1, S Ito 1, M Arakawa 1
PMCID: PMC1752569  PMID: 9709179

Abstract

OBJECTIVE—To clarify the characteristics of renal haemodynamics in patients with lupus nephritis (LN).
METHODS—The glomerular filtration rate (GFR) and renal plasma flow (RPF) of 37 patients with active LN were studied longitudinally over an interval of 8 to 144 weeks during treatment with corticosteroids or cytotoxic drugs, or both. All patients had clinical renal disorders and underwent renal biopsies.
RESULTS—Analysis of renal biopsy specimens showed that 31 patients had class IV LN. Class II, III, and V LN were present in two patients each. The average GFR increased significantly from 65.4 (SD 33.0) in the pretreatment stage to 86.6 (31.6) ml/min in the post-treatment stage, accompanied by an improvement in urinary or immunological abnormalities, or both. On the other hand, RPF decreased significantly from 625.2 (243.0) to 519.8 (179.0) ml/min. Therefore, the filtration fraction (FF) increased significantly from 10.7 (4.3)% to 16.8 (3.7)%. Low FF was recognised predominantly in patients with class IV LN, but was also observed in patients with other classes. The FF returned towards normal irrespective of the degree of GFR recovery. No significant changes were observed in the levels of blood pressure.
CONCLUSION—A reduction in GFR out of proportion to the reduction in RPF as demonstrated by the low FF values was related to the severity of LN or disease activity, or both. Therefore, relative evaluation of GFR and RPF, namely the determination of FF, may be a useful clinical parameter to determine the status of LN.

 Keywords: systemic lupus erythematosus; lupus nephritis; renal haemodynamics; filtration fraction

Full Text

The Full Text of this article is available as a PDF (109.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Appel G. B., Cohen D. J., Pirani C. L., Meltzer J. I., Estes D. Long-term follow-up of patients with lupus nephritis. A study based on the classification of the World Health Organization. Am J Med. 1987 Nov;83(5):877–885. doi: 10.1016/0002-9343(87)90645-0. [DOI] [PubMed] [Google Scholar]
  2. Austin H. A., 3rd, Muenz L. R., Joyce K. M., Antonovych T. A., Kullick M. E., Klippel J. H., Decker J. L., Balow J. E. Prognostic factors in lupus nephritis. Contribution of renal histologic data. Am J Med. 1983 Sep;75(3):382–391. doi: 10.1016/0002-9343(83)90338-8. [DOI] [PubMed] [Google Scholar]
  3. BRUN C. Thiosulfate determination in kidney function tests; a simple method for the determination of thiosulfate in blood and urine. J Lab Clin Med. 1950 Jan;35(1):152–154. [PubMed] [Google Scholar]
  4. Bauer J. H., Brooks C. S., Burch R. N. Clinical appraisal of creatinine clearance as a measurement of glomerular filtration rate. Am J Kidney Dis. 1982 Nov;2(3):337–346. doi: 10.1016/s0272-6386(82)80091-7. [DOI] [PubMed] [Google Scholar]
  5. Björck S., Nyberg G., Mulec H., Granerus G., Herlitz H., Aurell M. Beneficial effects of angiotensin converting enzyme inhibition on renal function in patients with diabetic nephropathy. Br Med J (Clin Res Ed) 1986 Aug 23;293(6545):471–474. doi: 10.1136/bmj.293.6545.471. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Derksen R. H., Hené R. J., Kater L. The long-term clinical outcome of 56 patients with biopsy-proven lupus nephritis followed at a single center. Lupus. 1992 Feb;1(2):97–103. doi: 10.1177/096120339200100207. [DOI] [PubMed] [Google Scholar]
  7. Esdaile J. M., Abrahamowicz M., MacKenzie T., Hayslett J. P., Kashgarian M. The time-dependence of long-term prediction in lupus nephritis. Arthritis Rheum. 1994 Mar;37(3):359–368. doi: 10.1002/art.1780370309. [DOI] [PubMed] [Google Scholar]
  8. Favre H., Miescher P. A. Filtration fraction: an index of renal disease activity in patients with systemic lupus erythematosus. Proc Eur Dial Transplant Assoc Eur Ren Assoc. 1985;21:717–721. [PubMed] [Google Scholar]
  9. Kallenberg C. G., Schweitzer C., de Jong P. E., Donker A. J., van der Hem G. K. Decreased filtration fraction during active proliferative lupus nephritis: relation to disease activity and reversibility of renal function. Clin Nephrol. 1984 Nov;22(5):223–229. [PubMed] [Google Scholar]
  10. Kimberly R. P., Gill J. R., Jr, Bowden R. E., Keiser H. R., Plotz P. H. Elevated urinary prostaglandins and the effects of aspirin on renal function in lupus erythematosus. Ann Intern Med. 1978 Sep;89(3):336–341. doi: 10.7326/0003-4819-89-3-336. [DOI] [PubMed] [Google Scholar]
  11. Kimberly R. P., Plotz P. H. Aspirin-induced depression of renal function. N Engl J Med. 1977 Feb 24;296(8):418–424. doi: 10.1056/NEJM197702242960803. [DOI] [PubMed] [Google Scholar]
  12. Laitman R. S., Glicklich D., Sablay L. B., Grayzel A. I., Barland P., Bank N. Effect of long-term normalization of serum complement levels on the course of lupus nephritis. Am J Med. 1989 Aug;87(2):132–138. doi: 10.1016/s0002-9343(89)80687-4. [DOI] [PubMed] [Google Scholar]
  13. Lowenstein J., Schacht R. G., Baldwin D. S. Renal failure in minimal change nephrotic syndrome. Am J Med. 1981 Feb;70(2):227–233. doi: 10.1016/0002-9343(81)90754-3. [DOI] [PubMed] [Google Scholar]
  14. Magil A. B., Puterman M. L., Ballon H. S., Chan V., Lirenman D. S., Rae A., Sutton R. A. Prognostic factors in diffuse proliferative lupus glomerulonephritis. Kidney Int. 1988 Oct;34(4):511–517. doi: 10.1038/ki.1988.211. [DOI] [PubMed] [Google Scholar]
  15. Marre M., Chatellier G., Leblanc H., Guyene T. T., Menard J., Passa P. Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria. BMJ. 1988 Oct 29;297(6656):1092–1095. doi: 10.1136/bmj.297.6656.1092. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Nakano M., Ueno M., Nishi S., Suzuki S., Hasegawa H., Watanabe T., Kuroda T., Ito S., Arakawa M. Determination of IgA- and IgM-rheumatoid factors in patients with rheumatoid arthritis with and without nephropathy. Ann Rheum Dis. 1996 Aug;55(8):520–524. doi: 10.1136/ard.55.8.520. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Nossent H. C., Henzen-Logmans S. C., Vroom T. M., Berden J. H., Swaak T. J. Contribution of renal biopsy data in predicting outcome in lupus nephritis. Analysis of 116 patients. Arthritis Rheum. 1990 Jul;33(7):970–977. doi: 10.1002/art.1780330708. [DOI] [PubMed] [Google Scholar]
  18. PARRISH A. E., KRAMER N. C., HATCH F. E., WATT M. F., HOWE J. S. The relation between glomerular function and histology in acute glomerulonephritis. J Lab Clin Med. 1961 Aug;58:197–203. [PubMed] [Google Scholar]
  19. Patrono C., Ciabattoni G., Remuzzi G., Gotti E., Bombardieri S., Di Munno O., Tartarelli G., Cinotti G. A., Simonetti B. M., Pierucci A. Functional significance of renal prostacyclin and thromboxane A2 production in patients with systemic lupus erythematosus. J Clin Invest. 1985 Sep;76(3):1011–1018. doi: 10.1172/JCI112053. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Petri M., Bockenstedt L., Colman J., Whiting-O'Keefe Q., Fitz G., Sebastian A., Hellmann D. Serial assessment of glomerular filtration rate in lupus nephropathy. Kidney Int. 1988 Dec;34(6):832–839. doi: 10.1038/ki.1988.257. [DOI] [PubMed] [Google Scholar]
  21. Rahman M. A., Emancipator S. N., Dunn M. J. Immune complex effects on glomerular eicosanoid production and renal hemodynamics. Kidney Int. 1987 Jun;31(6):1317–1326. doi: 10.1038/ki.1987.145. [DOI] [PubMed] [Google Scholar]
  22. Rosenbaum J. L., Akhtar M., Kramer M. S., Raja R. M., Manchanda R., Lazaro N. Evaluation of clearance studies in lupus nephritis. Clin Nephrol. 1974;2(2):47–51. [PubMed] [Google Scholar]
  23. Rosner S., Ginzler E. M., Diamond H. S., Weiner M., Schlesinger M., Fries J. F., Wasner C., Medsger T. A., Jr, Ziegler G., Klippel J. H. A multicenter study of outcome in systemic lupus erythematosus. II. Causes of death. Arthritis Rheum. 1982 Jun;25(6):612–617. doi: 10.1002/art.1780250602. [DOI] [PubMed] [Google Scholar]
  24. Saito T., Nishi S., Karasawa R., In H., Hayashi H., Ueno M., Ogino S., Sugiyama N., Suzuki S., Maruyama Y. An ultrastructural study of glomerular basement membrane in rheumatoid arthritis patients with urinary abnormalities. Clin Nephrol. 1995 Jun;43(6):360–367. [PubMed] [Google Scholar]
  25. Schwartz M. M., Lan S. P., Bonsib S. M., Gephardt G. N., Sharma H. M. Clinical outcome of three discrete histologic patterns of injury in severe lupus glomerulonephritis. Am J Kidney Dis. 1989 Apr;13(4):273–283. doi: 10.1016/s0272-6386(89)80033-2. [DOI] [PubMed] [Google Scholar]
  26. Smeenk R., Brinkman K., van den Brink H., Termaat R. M., Berden J., Nossent H., Swaak T. Antibodies to DNA in patients with systemic lupus erythematosus. Their role in the diagnosis, the follow-up and the pathogenesis of the disease. Clin Rheumatol. 1990 Mar;9(1 Suppl 1):100–110. doi: 10.1007/BF02205557. [DOI] [PubMed] [Google Scholar]
  27. Stein J. H. Regulation of the renal circulation. Kidney Int. 1990 Oct;38(4):571–576. doi: 10.1038/ki.1990.244. [DOI] [PubMed] [Google Scholar]
  28. Steinhausen M., Endlich K., Wiegman D. L. Glomerular blood flow. Kidney Int. 1990 Nov;38(5):769–784. doi: 10.1038/ki.1990.271. [DOI] [PubMed] [Google Scholar]
  29. Sugita O., Tomiyama Y., Matsuto T., Okada M., Gejyo F., Arakawa M., Takahashi S., Watazu Y., Kaneda N. A new enzymatic method for the determination of inulin. Ann Clin Biochem. 1995 Nov;32(Pt 6):561–565. doi: 10.1177/000456329503200608. [DOI] [PubMed] [Google Scholar]
  30. Tan E. M., Cohen A. S., Fries J. F., Masi A. T., McShane D. J., Rothfield N. F., Schaller J. G., Talal N., Winchester R. J. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277. doi: 10.1002/art.1780251101. [DOI] [PubMed] [Google Scholar]
  31. Yoshida T., Ichikawa Y., Tojo T., Homma M. Abnormal prostanoid metabolism in lupus nephritis and the effects of a thromboxane A2 synthetase inhibitor, DP-1904. Lupus. 1996 Apr;5(2):129–138. doi: 10.1177/096120339600500208. [DOI] [PubMed] [Google Scholar]
  32. ter Borg E. J., de Jong P. E., Meijer S., Kallenberg C. G. Renal effects of indomethacin in patients with systemic lupus erythematosus. Nephron. 1989;53(3):238–243. doi: 10.1159/000185751. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES