Abstract: FR-PO603
Pure Membranous Lupus Nephritis (LN) and Renal Outcomes
Session Information
- Glomerular Diseases: Lupus and Vasculitis
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1302 Glomerular Diseases: Immunology and Inflammation
Authors
- Larned, Catherine, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Gordon, Sarah M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Olson, Stephen W., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Costa, Gillian, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Background
Previous LN studies are mostly comprised of patients with proliferative LN (PLN) with only a small subgroup of membranous LN (MLN). Therefore, MLN is less well characterized. We sought to describe clinical characteristics, treatment, and renal outcomes in the largest and most diverse MLN cohort with the longest follow-up to date.
Methods
We used a Military Health System (MHS) ICD9/ICD10 code query to identify and an electronic record review to confirm 105 biopsy-proven adult MLN patients without concomitant PLN. We collected demographic, clinical, treatment and outcome data for each MLN case.
Results
Median follow-up was 93 months (7.75 years). The cohort was predominantly black (61%), female (74%), and young (median age 35 years). Median serum creatinine (SCr), estimated glomerular filtration rate (eGFR), urine protein/Cr ratio, and serum albumin at diagnosis were 0.80 mg/dL, 98 ml/min/1.73m2, 3.28 gm and 2.8 g/dL, respectively. Proteinuria at diagnosis was not associated with doubling of SCr (3.4 vs. 3.3gm, p=0.81) but reduction of proteinuria to <1gm was associated with lower likelihood of doubling Scr (36.4 vs. 83.0% p=0.001). Complete remission (CR,) reduction in proteinuria to <0.5gm and <15% reduction in eGFR within one year, was also associated with a lower likelihood of doubling SCr (8.3 vs. 55%, p=0.003) which remained significant after adjustment for age, race, and baseline eGFR [OR: 0.09 (CI: 0.01-0.80)], p=0.03]. Partial remission (PR,) at least 50% reduction in proteinuria to <3gm at one year, was not significantly associated with a lower likelihood of doubling SCr (54.6 vs. 66.7%, p=0.48). A majority of patients were on a renin-angiotensin system inhibitor (91.4%); 78.1% were treated with immunosuppressive therapy (7.8% treated with steroid only).
Conclusion
In this large MLN cohort with long follow up, reduction of proteinuria to <1gm or achievement of CR within one year of diagnosis was significantly associated with preservation of renal function, but partial remission alone was not. Despite overall superior renal prognosis of MLN compared to PLN, our findings suggest that providers should aim to achieve CR to preserve renal function.
Disclaimer: The views expressed in this Abstract are those of the authors and do not reflect the official policy of the Department of the Army/Navy/Air Force, the Department of Defense, or the United States government.