Abstract: FR-PO877
Characterization of Lupus Nephritis in a Predominantly Hispanic Population in the Western United States
Session Information
- Glomerular Diseases: Membranous Nephropathy, SLE, Complement
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Nguyen, Jim, Keck School of Medicine of USC, Los Angeles, California, United States
- Petrosyan, Nina, Keck School of Medicine of USC, Rolling Hills, California, United States
- Stone, Gregory, Keck School of Medicine of USC, Rolling Hills, California, United States
- Bedrossian, Nora, Keck School of Medicine of USC, Rolling Hills, California, United States
- Mert, Melissa, University of Southern California, Los Angeles, California, United States
- Shan, Hui Yi, Keck School of Medicine of USC, Los Angeles, California, United States
Background
Lupus Nephritis (LN) is a serious complication of systemic lupus erythematous (SLE). Both genetic and environmental factors play a role in disease manifestation and outcomes. Our study aims to characterize LN and its treatment in a predominantly Hispanic population residing in the Western US.
Methods
A retrospective chart review was conducted on all native kidney biopsies performed at Los Angeles County + USC Medical Center between 2008-2018. 124 patients with biopsy proven LN were identified.
Results
Among the total 124 patients, median age of diagnosis was 32 (26-42.5) years and the majority were female (87.8%) and self-reported as Hispanic (72.9%). The median serum creatinine and urine protein to creatinine ratio at baseline were 0.98 (0.71-1.92) mg/dl and 3.89 (1.47-6.32) mg/g, respectively. 72.6% had biopsies compatible with proliferative LN. Degree of tubular atrophy was significantly associated with remission status at 1-year (p=0.004). Subgroup analysis demonstrated better 1-year post induction partial (PR) and complete remission (CR) rates in patients who received mycophenolate (MMF) and steroid (29.7% PR, 51.4% CR) as compared to cyclophosphamide (CYC) and steroid (18.8% PR, 40.6% CR). Higher rate of relapse was observed in patients who received MMF and steroid compared to CYC and steroid (24.3% vs. 9.4%, respectively). A lower percentage of patients on MMF and steroid developed ESRD compared to patients treated with CYC and steroid (2.7% vs. 18.8%). A significantly higher proportion of patients who were not on hydroxychloroquine were diagnosed with ESRD compared with patients who were taking hydroxychloroquine (22.5% vs 6.5%, p=0.03).
Conclusion
Our study showed that this Hispanic cohort residing in the Western US presented early, with mildly elevated serum creatinine, minimal to no tubular atrophy, and primarily with proliferative LN. Of these treated patients, although it did not reach statistical significance, a noticeable trend was observed in achieving better remission rates at 1-year endpoint with MMF and steroid as induction therapy compared to CYC and steroid. Additionally, the use of hydroxychloroquine in this cohort is significantly associated with lower ESRD rate.