Renal remission status and long-term renal survival in lupus nephritis patients

Aim of the work

To compare long-term renal survival in lupus nephritis (LN) patients who achieved complete (CR), partial (PR), or no remission following LN induction therapy.

Patients and methods

Eligible patients with biopsy-proven LN were categorized into ordinal (CR, PR, or no remission) or binary (remission or no remission) at 6, 12, 24, 36 months post diagnosis according to modified Aspreva Lupus Management Study (mALMS) criteria. The primary endpoint was long-term renal survival.

Results

The study included 161 patients with LN, with a mean age 36.3 ± 8.2 years, age at biopsy 26.2 ± 7.4 years; 146 females and 15 males (F:M 9.3:1). All patients received induction therapy 6 months before or after biopsy with follow up duration ≥3 years. 114 (70.8 %) patients achieved long term survival, while 47 (29.2 %) ended up with end-stage renal disease (ESRD). Those with CR were more likely to have long-term survival (p < 0.001). A significant relation was found between maintenance therapies at different time points in those receiving azathioprine (AZA) (p = 0.002, p = 0.011, p = 0.016 and p = 0.003 respectively), as well as hydroxychloroquine (HCQ) (p < 0.003, p < 0.001, p = 0.011, p < 0.001 and p < 0.001 respectively) with long term survival. Cardiovascular and neuropsychiatric manifestations were significantly associated with ESRD/mortality (p = 0.003 and p = 0.002 respectively). The most significant predictor of long-term survival was complete remission at 6 months (β-3.745, p = 0.025).

Conclusion

In LN, renal remission was significantly associated with long term renal survival. Receiving AZA and HCQ have a significant association and CR at 6 months was the best predictor for long-term survival in LN patients.