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Kidney Week

Abstract: PUB229

Kidney Function in Patients with Lupus Nephritis Followed Up for a Very Long Time

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ayoub, Isabelle, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Wolf, Bethany, Medical University of South Carolina, Charleston, South Carolina, United States
  • Tsao, Betty, Medical University of South Carolina, Charleston, South Carolina, United States
  • Oates, Jim, Medical University of South Carolina, Charleston, South Carolina, United States
  • Rovin, Brad H., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Background

Most investigations of long-term kidney outcomes in patients with lupus nephritis (LN) focus on end-stage kidney disease (ESKD), but seldom on the proportion of patients left with chronic kidney disease (CKD). Both CKD and lupus are non-traditional risk factors for cardiovascular morbidity. We therefore looked at the development of CKD in a subset of LN followed for a very long time in an LN clinic.

Methods

A retrospective chart review was conducted in biopsy-proven LN patients followed for ≥10 years in a single-center, multidisciplinary LN clinic. Patients with CKD were defined as having an eGFR <60 ml/min/m2, and those with ESKD as having an eGFR <15 ml/min/2 or requiring permanent kidney replacement therapy. eGFR was determined by the clinical laboratories the patients used and was race adjusted. Results were analyzed with descriptive statistics.

Results

72 patients were followed for a median of 17.1 years (range 10 to 38.7) after LN was confirmed by kidney biopsy. The mean (± standard deviation, SD) age at diagnostic biopsy was 31.8±14.1 years. 21 patients were of African ancestry, 4 were Asian, and 47 were White. ESKD developed in 12 patients (16.7%) after a median of 14.6 years. At the time of last follow-up, 27 patients (37.5%) had CKD with a mean (±SD) eGFR of 40.4±13.0 ml/min/1.73m2. Of the 27 patients who developed CKD, 21 experienced at least one episode of eGFR <50 ml/min/1.73m2 that lasted for at least 6 months. Of the other 6 CKD patients, 4 (67%) had at least one 6 month (or longer) episode of proteinuria >3.5 g/d.

Conclusion

These data suggest that over 50% of LN patients may be at risk for developing ESKD or CKD if followed for 10 or more years. Almost all of these patients had sustained periods of kidney injury resulting in eGFR <50 ml/min/1.73m2, nephrotic-range proteinuria, or both preceding ESKD or CKD. Immunosuppression may not be sufficient to prevent CKD in LN. These patients may benefit from intense anti-progression therapy.