Abstract: PUB180
Clinicopathological Profile and Outcomes of Patients with Lupus Nephritis in South India
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Author
- Das, Uttara, All India Institute of Medical Sciences Mangalagiri, Guntur, Andhra Pradesh, India
Background
To characterize the demographic,clinicopathological,outcome, and complication profile of patients with lupus nephritis from south India.
Methods
This retrospective analysis included 57 SLE LN cases. Demographic data,histopathological classes (based on biopsies),immunofluorescence (IF) findings,treatment response at various follow- up periods (6-36 months)and recorded complications were analysed. Severe lupus nephritis cases were treated as per the NIH protocol. Induction therapy consisting of intravenous methylprednisolone (30 mg/kg body weight) administered for three consecutive doses at initiation,followed by monthly intravenous cyclophosphamide pulses for six months. Maintenance therapy included mycophenolate mofetil and a tapering dose of oral prednisolone,along with other supportive medications
Results
Mean age in years was 30.6+10,female: male was 10:1The most common histology was class IV and V (25.92% each) Class III 24 %,Mixed Classes (III + IV and IV+V) 5.55%,Class II 9.25 %and ClassI and VI for 1.85% IF 39.5% of cases full house pattern. Most frequent light chain deposition was lambda 54.1%(3+) Kappa 41.6%(3+). IgG was the most common deposited 72.9%(3+) and IgM 4.1%(3+). IgA was negative in 20.8% cases. C1q in 35.4%(3+),C3c in 25%(3+) cases. 21 cases were excluded. Out of remaining 36 patients complete remission seen in 38.2% partial remission in 50% no response (NR) in 8.33% death in 5.55% cases in first 6 months. In 12 months (25 cases) CR occurred in 48% PR in 32%,NR in 12%,relapse in 2.8%. In 18 months (17cases) CR occurred in 58.8% PR in 29.4%,relapse in 11.7%. In 24 months(11cases) CR in 72% cases,PR in 18.8%, NR in 9.09%. In 30months(5cases) CR occurred in 80% cases,relapse in 20%. The most frequent complication were leucopenia(15.7%), and Herpes zoster(10.5%). Urinary tract infection(5.26%); Tuberculosis and candidiasis (3.5%),Toxoplasmosis,thrombocytopenia,bilateral avascular necrosis of hip and septic arthritis in (1.7%).
Conclusion
Class IV and V were the most common presentation in South India with significant female predominance. Immunofluorescence frequently showed IgG,C1q and a dominant lambda light chain deposition. Early treatment showed promising response. CR rates increased with duration of treatment,relapse observed in few cases Leucopenia and Herpes infections were common adverse events.