Kidney Week

Abstract: TH-PO0753

Histologic Subtypes and Kidney Outcomes in Lupus Nephritis: Insights from a Diverse Cohort at a Quaternary Care Center

Session Information

• Glomerular Histopathology: Evolving Insights
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Bobart, Shane A., Houston Methodist, Houston, Texas, United States

Shane A. Bobart, MD, FASN

• Riaz, Maryam, Houston Methodist, Houston, Texas, United States

Maryam Riaz, DO

• Aveytia Camacho, Alma A, Houston Methodist, Houston, Texas, United States

Alma A Aveytia Camacho, MD

• Daliri, Soudabeh, Houston Methodist, Houston, Texas, United States

Soudabeh Daliri, MD

• Javed, Mahnoor, Houston Methodist, Houston, Texas, United States

Mahnoor Javed, DO

• Lowe, Jessica Elise, Houston Methodist, Houston, Texas, United States

Jessica Elise Lowe, MD

• Lin, Yueh-Yun, Houston Methodist, Houston, Texas, United States

Yueh-Yun Lin, MS, PhD

• Deva, Anshuj, Houston Methodist, Houston, Texas, United States

Anshuj Deva, MS

• Sanghvi, Aarjav Atik, Houston Methodist, Houston, Texas, United States

Aarjav Atik Sanghvi, MS

• Hickson, LaTonya J., Mayo Clinic in Florida, Jacksonville, Florida, United States

LaTonya J. Hickson, MD, FASN

• Aslam, Nabeel, Mayo Clinic in Florida, Jacksonville, Florida, United States

Nabeel Aslam, MD, FASN

• Adrogue, Horacio E., Houston Methodist, Houston, Texas, United States

Horacio E. Adrogue, MD, DrMed, FASN

• Guevara, Myriam, Houston Methodist, Houston, Texas, United States

Myriam Guevara, MD

• Edwards, Angelina, Houston Methodist, Houston, Texas, United States

Angelina Edwards, MD, FASN

Background

Lupus nephritis (LN), a serious manifestation of systemic lupus erythematosus (SLE), contributes significantly to long-term morbidity and mortality. While histologic classification guides treatment, its value in predicting renal outcomes remains uncertain. This study evaluates how histologic subtypes influence 12-month renal response post-biopsy to inform personalized treatment strategies.

Methods

We conducted a retrospective study of 216 kidney biopsies from June 2016 to December 2023 at Houston Methodist Hospital. Patients with isolated class I, II, or VI LN or missing follow-up were excluded. Data from 124 patients were analyzed and stratified by 2018 ISN/RPS classification. The primary outcome was complete renal response (CRR); secondary outcomes included partial response (PRR), non-response, and need for rescue therapy.

Results

The cohort was predominantly female (81%) and racially diverse (50% Black, 20% Hispanic/Latinx), with a mean age of 37.4 years. Histologic distribution: class III (16.1%), IV (25.8%), V (19.4%), IV+V (21.0%), and III+V (17.7%). At baseline, dsDNA positivity was highest in class IV (77.8%) and IV+V (77.3%) and lowest in class V (42.1%). dsDNA positivity declined in class IV (42.9%) but remained persistently high in IV+V (76.9%). Class IV+V patients had the worst baseline renal function: highest creatinine (2.82 mg/dL), lowest eGFR (34.6 mL/min/1.73m²), and highest UPCR (5.07 g/g). At 12 months, IV+V remained the poorest performing group: creatinine 3.31 mg/dL, UPCR 4.95 g/g, with 47.4% requiring hemodialysis. Induction therapy use (cyclophosphamide or rituximab) was most common in IV+V (CYC 40.9%, RTX 23.8%). CRR was highest in class V (42.9%) and III+V (38.5%), but lowest in IV+V (9.1%), where 63.6% had UPCR >3 and 30.8% required rescue therapy vs. 13.9% overall (p=0.019).

Conclusion

Class IV+V LN was associated with the worst renal function, persistent serologic (dsDNA) activity, and progression to dialysis. These findings support early, aggressive, and tailored treatment in this high-risk group and underscore the prognostic importance of biopsy classification in diverse populations.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025j83c0b42