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Abstract: SA-PO686

Repeated Renal Flares in Lupus Nephritis Are Associated With Decreased Response to Therapy, Progression of Kidney Disease, and Patient Survival

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Macedo, Sofia E. Márquez, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico City, Mexico
  • Pérez Arias, Abril A., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico City, Mexico
  • Zavala Miranda, María Fernanda, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico City, Mexico
  • Cruz, Cristinoc, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico City, Mexico
  • Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico City, Mexico
  • Mejia-Vilet, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico City, Mexico
Background

Repeated renal flares in lupus nephritis (LN) occur in some patients with systemic lupus erythematosus and have been associated with worse long-term kidney function. This study aimed to assess the impact of repeated LN flares in response to therapy, kidney and patient prognosis.

Methods

All patients from a well-characterized biopsy-proven LN cohort between 2008 and 2018 were segregated into three groups according to the number of LN flare when they entered our cohort: first LN flare, second LN flare, or third LN flare. The following outcomes were evaluated by unadjusted and adjusted time-to-event analyses: complete and partial response, disease relapses, progression to decline of 30% of the eGFR, doubling of serum creatinine, end-stage kidney disease, and patient survival.

Results

A total of 441 patients were included: 257 (58%) in their first LN flare, 102 (23%) in their second LN flare, and 82 (19%) in their third LN flare. There were significant differences in LN flare presentation in age, eGFR, serum albumin, pyuria, and hematuria among groups. The NIH chronicity indices and the percentage of patients with vascular lesions were higher in groups at progressive LN flares. In the adjusted analyses, complete and partial response rates decreased, as well as kidney and patient survival, at a progressive number of LN flares. No differences in the dynamic course of all surveillance laboratory parameters were observed in the first year after initial therapy among LN flare groups.

Conclusion

A progressive number of LN flares is associated with a lower response to therapy and an adverse prognosis for kidney function and patient survival. The history of LN flares should be accounted for in clinical practice and clinical trials in lupus nephritis.

Figure 1. Complete (A) and Partial (B) response rates for lupus nephritis patients in their first, second, or third flare.