Abstract: SA-PO251

Early Renin-Angiotensin System Blockade Improved the Short-Term and Long-Term Renal Outcomes of Lupus Patients with Antiphospholipid-Associated Nephropathy

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Yue, Cai, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  • Li, Guanhong, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  • Li, Xuemei, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  • Gao, Ruitong, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
Background

Antiphospholipid-associated nephropathy (aPLN) represents a constellation of renal vasculopathies associated with antiphospholipid antibodies. Coexisting aPLN is associated with more severe renal involvement and worsened renal outcome in patients with lupus nephritis. Our aim with this research was to investigate the renal protective effects of early renin-angiotensin-aldosterone system (RAAS) blockade in lupus patients with aPLN.

Methods

Medical data of 57 lupus patients with biopsy proven aPLN were analyzed. Early RAAS blockade was defined as administration of renin-angiotensin system inhibitors (RASI) within 3 months after kidney biopsy and continued for at least 12 months.

Results

Patients were comparable in demographic data, laboratory findings, and renal histology by the time of kidney biopsy, except that the RASI group had higher proteinuria level (5.2 [2.8-8.8] vs 1.9 [0.6-2.8]g/d, p=0.005) and higher prevalence of hypertension (75 vs 29%, p=0.001). The two groups were comparable in estimated glomerular filtration rate (eGFR), mean arterial pressure (MAP), and proteinuria level at 12 months after kidney biopsy. The improvement ratio of eGFR at 12 months was significantly higher in the RASI group (26 [-5, 86] vs -2 [-20, 20]%, p=0.028), and the rate of change in eGFR after 12 months were comparable between groups. During a mean 80-months follow-up, 4 (23%) patients in the non-RASI group and 3 (8%) patients in the RASI group developed kidney disease progression. Early RAAS blockade significantly decreased the risk of kidney disease progression (HR 0.11 [0.02-0.59]; p=0.009). Proteinuria and hypertension controls were comparable between groups.

Conclusion

Early RAAS blockade improved the short-term and long-term renal outcomes in lupus patients with aPLN. The renal protective effect of RASI was independent of its antihypertensive and antiproteinuric effects.

Cumulative incidence of kidney disease progression in lupus patients with aPLN. A, kidney disease progression defined as 30% decline of eGFR or ESKD. 2B, kidney disease progression defined as 15% decline of eGFR or ESKD.