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Kidney Week

Abstract: PO1598

Long-Term Outcomes of Lupus Nephritis in a Single Tertiary Care Center in South India

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kinjarapu, Srinivasa Naidu, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
  • Guditi, Swarnalatha, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
  • Herur, Siddharth, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
Background

Lupus nephritis (LN) is a frequent and severe manifestation of SLE, a risk factor for chronic kidney injury and end-stage renal disease in SLE we evaluated the clinical presentation and outcome with various treatment regimens in patients with lupus nephritis

Methods

A retrospective study in 50 patients with biopsy proven LN [class III (12),class IV(11),class V(4),class III+IV(10), class III+V(7), class IV+V(6)] treated with IVMP for 3 days followed by monthly CYC for 6 months and oral corticosteroids 0.5-1mg/kg with tapering to 10mg/day at the end of 6thmonth as induction protocol. AZA or MMF as maintenance regimen based on clinician discretion.Clinical presentation,histopathological (LM+IF) features,treatment regimen,treatment response and renal relapse and out comes were evaluated.

Results

Patients had a mean follow up of 3.6 years,clinical presentation nephrotic N.S (36%),nephritic Nes (24%), RPGN (16%),nephritic-nephrotic NS-NeS (12%),AKI (12%).patients who had RPGN and AKI presentation had crescentic GN and high chronicity index.46% attained complete remission(C.R),28% attained partial remission,26% did not respond to treatment(N.R) at the end of induction.15 and 8 patients out of 23 who attained complete remission were initiated on MMF and AZA as maintenance regimen respectively,13/15 in MMF group and 7/8 in azathioprine.patients continued to be in C.R at the end of 2 years, In patients who attained partial remission 5 on MMF, 5 on AZA, 4 on quarterly pulse doses of cyclophosphamide, 3/5 patients on MMF had C.R, 2/5 on AZA had C.R, 2/4 on quarterly pulse doses of CYC had C.R. 6 out of 13 non responders were not given maintenance regimen as patients progressed to CKD at the end of 6 months.4/7 patients who did not respond to CYC as induction were treated with MMF, 2 patient were treated with rituximab and one with triple immunosuppression(tacrolimus+MMF+corticosteroids) ,1 patient who treated with MMF and 1 patient who treated with rituximab attained partial remission, no patient attained complete remission at the end of 2 years

Conclusion

Induction regimen with cyclophosphamide is non inferior when compared to various other induction regimen in LN.Quartely pulse dose of CYC has no better out comes when compared to AZA and MMF as maintenance.Non responders at the end of 6 months of induction does not have better outcomes at the end of 2 years