Abstract:

Ｏｂｊｅｃｔｉｖｅ：To investigate the longterm outcomes of double filtration plasmapheresis （DFPP） combined with immunosuppressants in patients with severe lupus nephritis（LN）.
Ｍｅｔｈｏｄｏｌｏｇｙ：Sixty one severe LN patients (39 females and 22 males，median age 236  years with biopsy proven ( mainly class Ⅳ and Ⅴ+Ⅳ) from July 2009 to September 2017 were enrolled in the study.Among them，37(607%) patients showed rapidly progressive glomerulonephritis and 34(557%) needed renal replacement therapy at baseline with  SLEDAI 183±50,SCr 3156(2095,5340) μmol/L，29 patients had thrombotic microangiopathy (TMA) lesions.DFPP was performed with twofold plasma volume on each session using membrane type plasma component separator (EC50W and EC20W).All patients were given intravenous methylprednisolone (05 g/d×3～6d) and followed by glucocorticoids combined with immunosuppressants.The changes of SLEDAI and SCr after DFPP treatment,the ratio of patients free from dialysis at 3 months,the longterm efficacy and risk factors of renal survival were analyzed.
Ｒｅｓｕｌｔｓ：After DFPP treatment of 26±07 times,SLEDAI and SCr were decreased significantly with the titer of dsDNA.When treated for 3 months,urine analysis and serological indicators were further improved.588% (20/34) patients who needed renal replacement therapy at baseline were free from dialysis.3 patient were lost to followup.When followed up for 423 months,there were 19 patients entered end stage renal disease,21 patients achieved complete remission and 15 had partial remissionMultiple factor COX regression analysis found that chronicity index (CI) (HR=131,95% CI 106162) and baseline SCr (HR=2665,95% CI 33221370) were independent risk factors for the renal survivalDuring DFPP treatment, 4 patients had infections and 2 patients experienced coagulation dysfunction.
Ｃｏｎｃｌｕｓｉｏｎ：
DFPP combined with immunosuppressants can quickly  remove autoantibodies,relieve lupus activity and improve renal function.The longterm remission rate and renal survival rate were relatively high.CI and  baseline SCr were independent risk factors for renal survivalDFPP combined with immunosuppressants is an effective method for severe LN therapy.

Key words: lupus nephritis, double filtration plasmapheresis, clinical efficacy, renal outcome, risk factor