POS0793 PREDICTORS OF END STAGE RENAL DISEASE IN THE RENAL BIOPSY PROVEN LUPUS NEPHRITIS
Authors: E. Duran, T. Yildirim, U. Kalyoncu, A. Taghiyeva, E. Arzu Sağlam, M. Üner, E. Bilgin, J. Jabrayilov, E. C. Bolek, C. Önal, B. Farisoğullari, N. S. Koç, G. K. Yardimci, S. Girgin, G. Ayan, Z. Özsoy, G. Sandal Uzun, L. Kiliç, Ş. R. Yilmaz, A. Akdoğan, Ş. A. Bilgen, O. Karadag, S. Kiraz, B. Altun, A. İ. Ertenli, M. Arici, Y. Erdem
Journal: Annals of the Rheumatic Diseases (2021)

Background: Although focusing on the proliferative form of lupus nephritis (LN), recent reports also highlight the importance of recognizing and treating non-proliferative forms of LN. Objectives: In this study, we aimed to compare the clinical features and outcomes between proliferative and non-proliferative LN and to investigate the predictor factors of end stage renal disease (ESRD). Methods: This retrospective study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. 116 patients were diagnosed as LN. Biopsy findings had been classified according to the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) classification. Demographics, disease involvements, laboratory values, treatment regimens, and outcomes in LN course were compared according to the proliferative and non-proliferative LN. Complete renal response within first 24 months was defined as ACR response criteria. Factors predicting the ESRD were analysed by the logistic regression analysis. Results: A total of 116 lupus nephritis patients were categorised class 3 (n=17, 14.7%) or 4 (n=77, 66.4%) as proliferative LN and class 2 (n=9, 7.8%) or 5 (n=13, 11.2%) as non-proliferative LN. Of these patients, 80.2% was female. Mean age at the SLE diagnosis and SLE manifestations were similar for both group. ANA (+) ≥ 1:320, ds-DNA level, APS antibodies, anti-Sm (+) were similar for proliferative and non-proliferative LN, but ds DNA positivity and low level of C3 and C4 were more frequent in proliferative LN. LN duration was similar. Median renal SLEDAI scores were higher in proliferative LN group. Induction treatment regimens included pulse steroid 72.3%, CyC 51.8%, MMF 24.6%, Rtx 6.1%, CsA 4.4%, and plasma exchange 12.9%. ESRD, renal transplantation and exitus were major complications of LN. Predictors of ESRD were duration of lupus nephritis (OR 1.32 [1.09-1.61]; 95% CI), decrease in GFR at the biopsy time (OR 0.97 [0.95-0.99]; 95% CI), and being in complete renal response within 24 months (OR 21.07 [2.28-194.36]; 95% CI). Conclusion: Unfortunately, LN patients still have worse outcomes, such as high ESRD rate, regarding to current effective immunosuppressive treatment regimens. Although patients’ number were not enough for conclusion, interestingly, worse outcomes were not related with proliferative or non-proliferative LN. Complete remission within 24 months was most relevant good prognostic factor, and clinicians should be kept in mind to these windows of opportunity period. Table 1. Demographic, clinical characteristics, and outcomes of the patients with lupus nephritis Variables * All patients (n=116 ) Class 3 or 4 LN (n=94 ) Class 2 or 5 LN (n=22 ) p Age at the SLE diagnosis, years 22.5±13.1 23±13.3 20.3±14 0.32 Sex, female 93 (80.2) 74 (78.7) 19 (86.4) 0.42 SLE disease duration 8 (8.7) 8 (9.7) 8.3 (7.5) 0.66 Lupus nephritis at diagnosis time 67 (58.8) 54 (58.7) 13 (59.1) 0.97 Manifestation of SLE -Musculoscletal 75 (66.4) 63 (68.5) 12 (57.1) 0.32 -Mucocutaneous 60 (52.6) 50 (54.3) 10 (45.5) 0.45 -Hematologic 47 (40.9) 38 (40.4) 9 (42.9) 0.83 -Serosal 26 (23.2) 21 (23.1) 5 (23.8) 0.94 -Neurological 6 (5.3) 5 (5.4) 1 (4.8) 0.91 Laboratory values for kidney biopsy -Creatinine level (mg/dL ) 0.7 (0.5) 0.8 (0.5) 0.6 (0.2) 0.01 -GFR (ml/min ) 110 (67) 92 (55) 145 (59) 0.03 -≥ 60 ml/min 79 (79.8) 63 (77.8) 16 (88.9) -30-59 ml/min 8 (8.1) 7 (8.6) 1 (5.6) 0.55 -&lt; 30 ml/min 12 (12.1) 11 (13.6) 1 (5.6) -24-hour urine protein ≥ 1 gr/day 72 (71.3) 62 (76.5) 10 (52.6) 0.04 ≥ 3 gr/day 36 (35.6) 32 (39) 4 (21.1) 0.14 -Active urinary sediment 91 (83.5) 78 (89.7) 13 (59.1) 0.001 Renal SLEDAI at the biopsy 12 (8) 12 (8) 8 (8) 0.001 Lupus nephritis duration (years ) 5.5 (8) 5.1 (8.3) 6.4 (4.8) 0.73 Complete renal response within 24 months 69 (71.1) 55 (72.4) 14 (66.7) 0.61 End-stage renal disease 13 (11.2) 11 (11.7) 2 (9.1) 0.72 Renal transplantation 5 (4.3) 4 (4.3) 1 (4.5) 0.95 Exitus 8 (7) 7 (7.5) 1 (4.5) 0.62 * n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age. GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity index Disclosure of Interests: None declared