MP138EVALUATION OF LUPUS NEPHRITIS REMISSION IN THE COHORT PATIENTS FROM ONE CENTER

Abstract

Introduction and Aims: Lupus nephritis (LN) is on of the most severe manifestations of Systemic Lupus Erythematosus (SLE), mainly defining treatment modality and prognosis. We aimed to evaluate some demographic and clinical features, pathology patterns and long-term treatment results in the group of SLE patients, followed in our unit for 20 years. Methods: Using electronic database for 1994-2014, and specifically designed charts, we selected 173 SLE patients. Diagnosis was based on ACR criteria; kidney biopsy was evaluated according to ISN/RPS Classification. Initial treatment regimens included i.v. and oral steroids in combination with i.v. cyclophosphamide either mycophenolates or cyclosporine-A; subsequent treatment regimens included low-dose steroids combined with mycophenolates either azathioprine or cyclosporine-A. Hydroxychloroquine was added on top of any regimen since 2012. Complete response (CR) and partial response (PR) for LN were evaluated according to the degree of proteinuria, hematuria and serum creatinine level after 12 month of treatment and/or at the latest follow-up evaluation. SELENA/SLEDAI and SLICC indices were used for SLE activity and damage evaluation. Results: Study group included 27 (15.6%) males and 146 (84.4%) females, 161 (93.1%) of Caucasian and 12 (6.9%) of Asian origin, median age 29 [15; 70] years. Median follow-up period comprised 6 [1; 239] months. 100 (57.8%) patients with overt clinical manifestations of LN underwent kidney biopsy: Class I LN was found in 6 cases, Class II in 12, Class III in 17, Class IV in 39, pure Class V in 13, Class V plus Class III/IV in 3, and Class VI - in 10 cases. In 15 patients second kidney biopsy was performed and showed transitions from Class II to Class I, from Class V plus III/IV to pure Class V, and from Class IV to Class VI. Patients without pathology-proven LN were excluded from further analysis, among 100 who got kidney biopsy 36 achieved CR of LN, 48 - PR, in 16 cases treatment was ineffective. 17 (20.8%) patients out of 84, who achieved remission, subsequently developed renal flares. At the end of the study period 48 out of 100 patients are alive and not on dialysis, 8 receive dialysis, 10 patients died, and 34 were lost to follow-up.48 patients were evaluated for LN remission status, SLE activity and damage accrual at the latest follow-up visit during 2014. In this cohort 31 (64.5%) achieved and maintained CR, 15 (31.2%) - PR, and only 2 (4.1%) did not respond to the therapy. SELENA/SLEDAI and SLICC data are shown in Table 1. Conclusions: In our SLE patients population prevailed young women of Caucasian origin with lupus nephritis, mainly (59%) diffuse or focal proliferative by pathology. Initial treatment efficacy turned to be 84%, with 21% of renal flares during subsequent treatment. Almost half of biopsy proven cases of LN was available for evaluation at the end of the study period. Number of remissions increased to 95%, which confirms the efficacy of prolonged initial treatment. 31 out of 48 achieved CR of LN, but only 20 of them were scored as 0 by SELENA/SLEDAI Activity Index, the rest 11 with LN CR but scored as 2 or more by SELENA/SLEDAI had only serology abnormalities. Damage accrual was relatively low and defined mostly by steroid cataract, diabetes, osteoporosis or incomplete recovery of kidney function. (Table Presented).