AB0504 CLINICOPATHOLOGICAL CHARACTERISTICS AS POSSIBLE PREDICTOR OF RENAL OUTCOME IN PATIENTS WITH ACTIVE LUPUS NEPHRITIS FOLLOWING THE INDUCTION OF REMISSION PHASE
Authors: Faisal Elbadawi, Munther Khamashta, Nasir Elsidig, Jamal Alsaleh
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Systemic lupus erythematosus is polygenic autoimmune rheumatic disease with heterogeneous manifestations. Lupus patients with nephritis signal represents management challenge. With current induction and maintenance therapy the risk of developing lupus nephritis related ESRD at five, ten and fifteen years remains 11,17 and 22% for the last decade <h3>Objectives:</h3> To study clinicopathological characteristics of lupus nephritis patients as well as short term renal outcome following induction of remission attempts. <h3>Methods:</h3> Retrospective, prospective observational study. We enrolled all patients with suspected active Lupus nephritis attending Dubai Hospital Rheumatology services. Data collected during outpatient, inpatient consultation using medical electronic system for all patients newly diagnosed to have lupus with renal involvement or patients who had nephritic or nephrotic flare from June 2016 till December 2018 <h3>Results:</h3> Of 71 patients included during the study period, mean age was 36.4 years, 93% were female while 7% were males.56 Out of 71 were Arab (78%) while the rest 15 out of 71 (22%) from non-Arab ethnicity. 84% (60/71) patients suspected to have active lupus nephritis underwent ultrasound guided kidney biopsy unless contra-indicated or the patient refused to sign the consent for the procedure. The commonest histopathological class according ISN/RPS 2003 Classification was class III. Induction of remission attempted with Mycophenolate Mofetil in 29% of patients (21/71). Around (8/71) received Rituximab regimen while more than 50% of the patients (39/71) received Cyclophosphamide Euro lupus protocol. At 6 months assessment following induction of remission 40/71 showed complete response and 26/71 responded partially, 5/71 required dialysis 2 of them required short term dialysis. On the other hand 3/71 (4%) progressed to end stage renal disease. Among patients who developed end stage renal disease there was signal of less favorable prognostic indicators such comorbid condition with possible glomerulopathy complications such as diabetes mellitus and hypertension. Moreover 2 of the 3 patients end with long term dialysis observed to have positive Antiphospholipid antibody status which may reflect co-existing thrombotic angiopathy. Among biopsy criteria predicting worse outcome was the presence of Cellular crescents on background of Class III or IV lupus nephritis. <h3>Conclusion:</h3> Our study is unique in the region, characterizing high risk group of SLE patients. The signal of co morbid conditions such as hypertension, diabetes mellitus and antiphospholipid antibody positivity as well as class III/IV Lupus nephritis with cellular crescents as predictor of worse renal outcome raise the unmet need for further study with large sample involving more than single center to determine clinical, serological and histopathological predictors of renal outcome in short term as well as long term with the available immune suppressive regimens. <h3>References</h3> [1] G K Bertsias, Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis, Ann Rheum Dis. 2012; 71(11): 1771–1782. [2] JAN J. WEENING, The Classification of Glomerulonephritis in Systemic Lupus Erythematosus Revisited, J Am Soc Nephrol 2004, 15: 241–250 <h3>Disclosure of Interests:</h3> None declared