Abstract: FR-PO1108
Progressive Improvement of Renal Survival over the Last Five Decades in 499 Italian Patients with Lupus Nephritis
Session Information
- Glomerular Diseases: Clinical, Outcomes, Trials - II
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Moroni, Gabriella, IRCCS Fondazione Ca Granda Ospedale Policlinico Milano, Milan, Italy
- Raffiotta, Francesca, IRCCS Fondazione Ca Granda Ospedale Policlinico Milano, Milan, Italy
- Vaglio, Augusto, Parma University Hospital, Parma, Italy
- Messa, Piergiorgio, IRCCS Fondazione Ca Granda Ospedale Policlinico Milano, Milan, Italy
- Sinico, Renato Alberto, AO San Carlo Borromeo, Milano, Italy
Background
To examine the changes in lupus nephritis (LN) prognosis during the course of the last fifty years and to search for the prognostic factors associated with patient and renal outcomes.
Methods
Four hundred and ninety-nine patients (pts) (85.6% women) were included in the study; they were followed for a median period of 10.6 years (IQR 4-18). They were diagnosed from 1970 to 2016 and were subdivided into three periods (P) based on the year of LN diagnosis: P1 1970-1985: 106 pts; P2 1986-2001: 158 pts; P3 2002-2016: 235 pts.
Results
As Induction therapy, in each period, more than 2/3 of pts received methylprednisolone pulses, and more than 50% received cyclophosphamide. Azathioprine was given to 16% of pts in P1, 12% in P2, and 4% in P3, mycophenolate mofetil (MMF) in 3% of pts in P2 and in 34% in P3. For maintenance therapy, azathioprine and MMF were used respectively in P1 in 28% and in 1% of patients, in P2 in 39% and in 15%, and in P3 in 30 and in 54%. The CKD free survival at 10 and at 20 years was 75% and 66% in P1, 85.5% and 80.2% in P2 and 91.5% in P3 (p=0.0069). The ESRD free survival at 10 and at 20 years were respectively 87% and 80% in P1, 94% and 90% in P2 and 99% in P3 (p=0.0019). Patient survival at 10 and at 20 years were respectively: in P1 94% and 87%, in P2 98% and 94% and in P3 95%.
At multivariate analysis, carried out in the entire cohort, among the characteristics at presentation, Log serum creatinine (RR 2.39 for any increase in Log serum creatinine), high activity (RR 1.06 for any unit increase in activity index) and chronicity index (RR 1.13 for any unit increase in chronicity index), arterial hypertension (RR4.16) and the absence of maintenance immunosuppressive therapy (RR 2.08) predicted CKD. The same features predicted ESRD with the addition of male gender (RR 3.34). Male gender (RR 2.88), older age (1.07 for any increase in one year of age) and Log serum creatinine (RR1.8) were independent predictors of death.
Conclusion
The progressive improvement in renal survival in our cohort is the result of a comprehensive approach, which includes a prompt diagnosis of renal involvement, treatment based on renal biopsy, and increased clinical experience in the management of LN complications.
