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Abstract: SA-PO690

Systemic Lupus Erythematosus (SLE) Nephritis and COVID-19

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Pavuluri, Lakshmi Aishwarya, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Yalamanchili, Venkata A., Dallas Nephrology Associates, Dallas, Texas, United States
  • Rapur, Ram, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Group or Team Name

  • Nephrology, SVIMS, Tirupati
Background

We report the outcomes of renal biopsy proven SLE nephritis patients after COVID-19 infection from Sri Venkateswara Institute of Medical Sciences (SVIMS), a tertiary care referral center and University Hospital in Tirupati,India.

Methods

Our institute has been declared as State COVID-19 hospital in the last week of the March 2020. From then, till now we had admitted and managed COVID-19 patients from several districts of Andhra Pradesh and neighbour states. We collected the data of patients with biopsy proven SLE nephritis contemporaneously from admission to the outcomes on a computerised proforma.
We employed the following statistics. For the data of continuous variables and categorical variables, student t test and chi square tests were used respectively. For the risk factors for mortality univariate linear regression was used. We used Medcalc free online software.

Results

We had identified sixteen patients of SLE nephritis admitted with COVID-19 disease. Of them fourteen were females and two were males. The mean age was 29.3 years.Out of sixteen patients, seven patients, required mechanical ventilator and dialysis and eventually died during their hospitalization. One more patient expired due to disseminated tuberculosis (50%). We identified the patients who died were of younger age, had higher serum creatinine at presentation, higher CT severity score and lower serum albumin as factors which had significant effect on mortality.

Conclusion

Of the more than 20 studies published on SLE patients with COVID-19, none of the studies focussed on the lupus nephritis. Our results suggested that with the approximately 50% mortality the COVID -19 disease had a calamitous effect on SLE nephritis patients.

Parameters related to systemic lupus erythematosus nephritis
ParameterResult before COVID-19 diseaseResult during/after COVID-19 disease
Anti dsDNA titre (reference range: > 40 WHO IU/mL - positive)163.8 ±30.3147.6 ± 23.0
Complement C3 (reference range : 91 – 156 mg/dL)70.9 ± 8.981.0 ± 7.6
Complement C4(reference Range : 20 – 50 mg/dL)18.4 ± 2.121.3 ± 4.5
Serum creatinine (mg/dL) in patients without renal failure (n=8) (mean ± SD) (range)1.17±0.20 (0.9-1.4)1.32 ± 0.22 (1.05-1.24)
Serum creatinine (mg/dL) in patients with renal failure (n=8) (mean ± SD) (range)7.82 ± 3.25 (3.5-12.1)9.0±3.0 (6.1-11.9)
Renal biopsy in SLE patients admitted with COVID-19 (n=16)Class IV: 10
Class III+V: 4
Class V: 2
Class VI: 1*
Treatment of SLE nephritisSteroids, cyclophosphamide and ACE inhibitionSteroids

* A 17-year-girl, SLE nephritis Class IV diagnosed before COVID-19 presented with haematuria after the diagnosis of COVID-19. A repeat renal biopsy done during COVID-19 disease revealed crescents