AB1042 LUPUS NEPHRITIS IN LATE VERSUS EARLY ONSET SYSTEMIC LUPUS ERYTHEMATOSUS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: S. Abi Doumeth, M. Magrey, N. Desai, O. Pamuk
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Lupus nephritis (LN) is a severe manifestation of systemic lupus erythematosus (SLE) and can be present in both early-onset (age less than 50) (eSLE) and late-onset lupus (age greater than 50) (ltSLE) patients, with distinct differences in clinical features, prognosis, and treatment strategies. Understanding these differences is crucial for optimizing outcomes of LN in different age groups. <h3>Objectives:</h3> We performed a systematic review and meta-analysis to evaluate the differences in renal manifestations (lupus nephritis, end stage renal disease (ESRD), proteinuria, nephrotic syndrome) in ltSLE patients compared to eSLE patients. <h3>Methods:</h3> Literature search was performed using PubMed, Web of Science and the Cochrane Library. Cohorts, case-control, and population-based studies have been included. PRISMA 2020 guidelines and checklist were used (Flow chart attached). Studies were included if they investigated the frequency of LN in ltSLE patients and excluded if they did not include an eSLE control group. The diagnosis of SLE and LN (persistent proteinuria greater than 500 mg/day or cellular casts) was based on ACR 1997 revised classification criteria. Two authors independently reviewed all articles and evaluated the data for consistency between the abstracts, tables, and text. Forest plot was used to compare odds ratios (95% CI) of renal manifestations by age groups. Study heterogeneity was assessed using I<sup>2</sup>. All analyses were performed using R Statistical Software meta package (v4.2.1; R Core Team 2022) <h3>Results:</h3> 45 eligible studies comprising 22,511 SLE patients (19307 eSLE and 3204 ltSLE) were included in the analysis. The frequency of LN was more common in eSLE group compared to ltSLE (OR: 2.37, 95% CI: 2.16-2.61, p&lt;0.0001) (Figure 1). Further analysis of 12 studies showed that proteinuria was more frequent in eSLE when compared to ltSLE (OR: 1.9, 95%CI: 1.66-2.18, p=0.0001) while data from 9 studies showed that nephrotic syndrome was more frequent in eSLE than in ltSLE (OR: 4.42, 95%CI: 2.85-6.84), p&lt;0.0001). Hypocomplementemia was more common (OR: 2.63, 95%CI: 2.29-3.02, p&lt;0.0001) and positive dsDNA was more frequent in the eSLE group (OR: 1.33 95%:1.18-1.51, p&lt;0.0001). The development of ESRD was reported in 12 studies. ESRD rate was higher in the eSLE than in ltSLE, but the difference was not statistically significant (OR: 1.45, 95% CI: 0.95-2.23, p=0.08). <h3>Conclusion:</h3> In this study, overall frequencies of LN, nephrotic syndrome, proteinuria, hypocomplementemia and elevated dsDNA were more common in eSLE patients compared to ltSLE. ESRD development tended to be higher in eSLE patients. These findings underscore the need for a high index of suspicion for LN in an older SLE patient population, particularly considering the high frequency of comorbid conditions such as diabetes, hypertension and vascular disease that can contribute to renal dysfunction. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Sarah Abi Doumeth: None declared, Marina Magrey Yes, however, not related to SLE. Novartis, Eli, Lilly, Pfizer, Abbvie, Janssen, UCB pharma. , Niraj Desai: None declared, Omer Pamuk: None declared.