How Do Lupus Nephritis Patients Who Achieve Renal Remission Fare? A 3-year Comparison in Terms of GFR Decline

Jorge Guerra Sayre¹, Andrea Fava², Daniel Goldman³, Laurence Magder⁴ and Michelle Petri³, ¹Johns Hopkins University School of Medicine, Baltimore, MD, ²Johns Hopkins University, Baltimore, MD, ³Johns Hopkins University School of Medicine, Timonium, MD, ⁴University of Maryland, Baltimore, Baltimore, MD

Meeting: ACR Convergence 2024

Keywords: Lupus nephritis, Renal, Systemic lupus erythematosus (SLE)

Session Information

Date: Sunday, November 17, 2024

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster II

Session Type: Poster Session B

Session Time: 10:30AM-12:30PM

Background/Purpose: Lupus nephritis (LN) occurs in over 50% of SLE patients, contributing significant morbidity and mortality. Despite a generally accepted treatment goal of Complete Renal Response (CRR) at one year, concerns for damage accrual remain, raising the question of whether a more stringent proteinuria goal renal remission (RR) should be pursued.

Methods: CRR at one year after renal biopsy, was defined as urine protein creatinine ratio (UPCR) ≤ 0.50 g/g, and < 10 mg/day of prednisone. RR at one year after renal biopsy, was defined as UPCR ≤ 0.20 g/g, and < 5mg/ day of prednisone. We identified patients with biopsy classes: III, IV, or mixed III+V or IV+V per International Society of Nephrology/ Renal Pathology Society (ISN/RPS) classification criteria. Estimated Glomerular Filtration Rate (eGFR) was assessed at baseline and approximately 3 years post-baseline using the 2021 CKD-EPI formula without race. Based on these measures, three long-term outcomes were evaluated: mean 3-year GFR, change in GFR, and proportion with a 30% decline in eGFR from baseline.

Results: 60 patients had a qualifying biopsy and at least 3 years of follow-up data. Patient demographics and characteristics are summarized in Table 1. CRR was achieved in 25 patients (40%) and RR in 12 patients (19%) one year after biopsy. White patients were more likely to achieve RR (43%) compared to Black patients (11%). Compared to patients who did not achieve CRR, both CRR and RR demonstrated a higher eGFR and smaller declines in GFR at the 3-year assessment, but these differences were not statistically significant (Figure 1). There was a statistically significant difference in the proportion who had a 30% decline in eGFR (Table 2). No differences were observed between those who achieved RR and those who achieved CRR but not RR, with respect to three-year outcomes.

Conclusion: Renal remission is rare at one year (only 19% of our patients). Both RR and CRR had lower GFR decline compared to non-responders. In fact, compared to non-responders, patients with either CRR or RR did not experience a 30% decline in GFR, which was statistically significant.

Table 1: Number (%) of patients classified as CRR, RR, or neither, by patient characteristics.

Figure 1: Comparison of GFR Decline Slopes Over 3 Years.

Table 2: Proportion (%) with a 30% decline in GFR between baseline and 3-years post baseline.

Disclosures: J. Guerra Sayre: None; A. Fava: Annexionbio, 2, Arctiva, 2, AstraZeneca, 2, Exagen, 5, Novartis, 6, UCB, 2; D. Goldman: None; L. Magder: None; M. Petri: Amgen, 2, AnaptysBio, 2, Annexon Bio, 2, Arthros-FocusMedEd, 6, AstraZeneca, 2, 5, Atara Biosciences, 2, Aurinia, 5, 6, Autolus, 2, Avoro Ventures, 2, Biocryst, 2, Boxer Capital, 2, Cabaletto Bio, 2, Caribou Biosciences, 2, CTI, 1, CVS Health, 1, Eli Lilly, 2, 5, Emergent Biosolutions, 1, Ermiium, 2, Escient Pharmaceuticals, 2, Exagen, 5, Exo Therapeutics, 2, Gentibio, 2, GlaxoSmithKlein(GSK), 2, 5, iCell Gene Therapeutics, 2, Innovaderm Research, 2, IQVIA, 1, Janssen, 5, Kira Pharmaceuticals, 2, Merck/EMD Serono, 1, Nexstone Immunology, 2, Nimbus Lakshmi, 2, Novartis, 2, PPD Development, 2, Precision Biosciences, 2, Proviant, 2, Regeneron Pharmaceuticals, 2, Sanofi, 2, Seismic Therapeutic, 2, Senti Bioscienes, 2, Sinomab Biosciences, 2, Takeda, 2, Tenet Medicines Inc, 2, TG Therapeutics, 2, UCB, 2, Vertex Pharmaceuticals, 2, Worldwide Clinical Trials, 1, Zydus, 2.

To cite this abstract in AMA style:

Guerra Sayre J, Fava A, Goldman D, Magder L, Petri M. How Do Lupus Nephritis Patients Who Achieve Renal Remission Fare? A 3-year Comparison in Terms of GFR Decline [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/how-do-lupus-nephritis-patients-who-achieve-renal-remission-fare-a-3-year-comparison-in-terms-of-gfr-decline/. Accessed .

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