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Abstract: PO1927

Vasculopathy Associated with Lupus Nephritis (Severity and Outcomes)

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Torres, Marcial, Ochsner Clinic Foundation, Ochsner Health System, New Orleans, Louisiana, United States
  • Alqudsi, Muhannad, Ochsner Clinic Foundation, Ochsner Health System, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Ochsner Clinic Foundation, Ochsner Health System, New Orleans, Louisiana, United States
  • Mohamed, Muner, Ochsner Clinic Foundation, Ochsner Health System, New Orleans, Louisiana, United States
Background

Lupus nephritis (LN) is common in patients with systemic lupus erythematosus. Classification, prognosis, and treatment considerations of LN relays mainly on kidney biopsy features. Although few observational studies showed LN with vasculopathy has more severe course, literature reviews are scarce and mostly from Asian populations. The goal of the study was to shed more light on severity and response to Immunosuppression (IS) therapy in this subgroup of LN.

Methods

This was a single center retrospective chart review of LN patients from 2010-2019. Inclusion criteria were adult patients with native kidney biopsy proven LN documented in chart. Patients with systemic thrombotic microangiopathy (TMA) or possible secondary cause of renal TMA (other than SLE) were excluded. Two groups were identified for comparison, LN without vasculopathy (WOV) and LN with vasculopathy (WV). Vasculopathy was defined from kidney biopsy as vascular sclerosis (at least moderate), vascular immunoglobulins deposits, vasculitis, or TMA. Creatinine (Cr), albumin (Alb), urine protein-creatinine ration (UPCR), end-stage renal disease (ESRD) and treatment regimens were compared, p-values are calculated by Mann Whitney, chi square and ANOVA of repeated measures.

Results

There were 431 patients with LN, 65 patients qualified for the study. patients with LN-WOV (n=38), and LN-WV (n=27). Racial demographics: 49=black (75%),14=white (21%), 1=Hispanic, 1=Asian. Females 57 (88%). Median age 37 years. Average follow-up 3.5 years. Induction IS regimen for LN-WOV was mycophenolate mofetil (MMF) in 52%, Cyclophosphamide (CYC) in 11%, and Rituximab (RTX) in 15%. In LN-WV induction IS regimen was MMF in 52%, and CYC in 23%. At baseline, mean values of Cr 1.7 mg/dL, Alb 2.5 g/dL and UPCR 3.7 g/g for LN-WOV and LN-WV were similar (p = 0.38, 0.37, 0.53, respectively). At 6 and 12 months of follow-up, mean values of Cr, Alb, and UPCR remained similar (p = 0.59, 0.49, and 0.64 for 6 months, and 0.34, 0.41, 0.53 for 12 months). No difference was found in ESRD events: 7 (18%) in LN-WOV and 5 (18%) in LN-WV, p=0.86.

Conclusion

In our cohort, both groups of LN-WOV and LN-WV showed no statistical difference in the severity of presentation, nor in response to IS therapy assessed at 6 and 12 months follow-up of Cr, Alb, and UPCR, and ESRD. Hence, LN-WV was not associated with ominous outcomes or more resistance to IS.