Abstract: SA-PO0819
Association of Lupus Nephritis Histologic Class with Serologic Markers and 12-Month Outcomes
Session Information
- Glomerular Diseases: Management, Evolving Strategies, and Practice-Changing Advances
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Fatfat, Adnan, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Batish, Ishaan, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Sharma, Abhinav, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Arevalo Salazar, Dory E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Albadri, Sam, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Aslam, Nabeel, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Bobart, Shane A., Mayo Clinic in Florida, Jacksonville, Florida, United States
Background
Anti-dsDNA positivity and hypocomplementemia are often used as markers of active lupus nephritis (LN), but their association with histologic phenotype and kidney outcomes remains incompletely defined. We evaluated whether conventional serologic markers reflect differences across LN histologic classes -pure proliferative (PLN), pure membranous (MLN) and mixed proliferative/membranous (mixed LN) - and their association with short-term kidney outcomes.
Methods
We conducted a retrospective cohort study of 88 patients with biopsy-proven LN and 12-month follow-up. Patients were categorized into three groups based on ISN/RPS histologic classification: PLN (class III/IV), MLN (class V), and mixed LN (III/IV+V). Baseline and 12-month characteristics were compared between groups, including demographic, clinical, serological, and treatment variables. Outcomes at 12 months included renal progression (death, dialysis, transplant, or eGFR decline >40%), complete and partial proteinuria remission (≤0.5 g/day and ≤1 g/day, respectively). Multivariable logistic regression examined the association between LN class and outcomes, adjusting for age, sex, baseline eGFR, and baseline proteinuria.
Results
Among 88 patients, 36 had PLN, 26 had MLN, and 26 had mixed LN. At baseline, dsDNA levels were highest in PLN (median 326 IU/mL [IQR 116, 668]), followed by mixed LN (181 [86.9, 461]) and MLN (38.9 [12.3, 123]) (p=0.001). Baseline C3 and C4 levels were significantly lower in PLN and mixed LN compared to MLN (p=0.003 and p=0.017, respectively), while eGFR and proteinuria were similar across groups. At 12 months, dsDNA levels remained significantly different across groups (PLN 41.5, mixed LN 57.9, MLN 12.3 IU/mL; p=0.01), paralleled by higher dsDNA positivity in mixed LN (80%) compared to PLN (51.7%) and MLN (30%) (p=0.006). C3 and C4 levels were comparable among groups. In multivariable analyses, LN classes were not associated with renal progression, complete or partial proteinuria remission at 12 months
Conclusion
Serologic markers differed across LN classes, with greater immunologic activity in PLN and mixed LN compared with MLN; however, this did not translate into differences in short-term kidney outcomes. These findings underscore that serology could inform suspicion for LN class but cannot replace kidney biopsy or independently define short-term renal prognosis.