Newly Diagnosed Lupus Nephritis in Elderly Predicts Good Renal Outcome: A Distinct Disease Subset from Young-onset Lupus Nephritis

Kazuoto Hiramoto¹, Hironari Hanaoka ¹, Jun Kikuchi ¹, Shuntaro Saito ¹, Hiroshi Takei ², Tatsuhiro Oshige ¹, Noriyasu Seki ³, Hideto Tsujimoto ³, Yuko Kaneko ¹ and Tsutomu Takeuchi ¹, ¹Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan, ²Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, ³Mitsubishi Tanabe Pharma Corporation Sohyaku. Innovative Research Division, Toda-shi, Saitama, Japan

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Lupus nephritis, regulatory cells and Elderly, Systemic lupus erythematosus (SLE)

Session Information

Date: Sunday, November 10, 2019

Title: SLE – Clinical Poster I: Epidemiology & Pathogenesis

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Elderly-onset SLE is recognized to be benign disease entity with a favorable nature course. Although late-onset lupus nephritis (LN), long interval between onset of SLE and diagnosis of LN is associated with poor renal outcome, little information has been available in newly diagnosed LN in the elderly. The purpose of this study is to compare renal prognosis and clinical characteristics between elderly-onset and young-onset LN.

Methods: We reviewed SLE patients with LN from 2000 to 2018 in our hospital. LN was defined as biopsy-proven LN or persistent proteinuria (more than 0.5 g/gCr or ≥3+ for more than 3 months). Patients were classified into two groups based on disease onset: young-onset LN (< 50 years old) and elderly-onset LN (≥50 years old). Deterioration of renal function (more than 30% eGFR decline from baseline) and circulating regulatory T (Treg) cell counts were compared by fluorescence-activated cell sorting (FACS) analysis using anti-CD3, 4, 25, 127 antibodies between them.

Results: Fifty-three patients with young-onset LN and 9 with elderly-onset LN were evaluated. Baseline eGFR was significantly lower in patients with elderly-onset LN than young-onset LN (63.3±19.0 vs 93.4±23.5 ml/min, p< 0.01). There was no significant difference in baseline SLEDAI (16 vs 16, p=0.33), observational periods (8 vs 10, p=0.47), maximum dose of prednisolone (p=0.42), percentage of IVCY use (p=0.15) and MMF use (p=0.46) between the two groups. Cumulative deterioration rate of renal function tended to be lower in the elderly than young-onset LN (p=0.10, Figure 1). A higher tendency of peripheral Treg (CD3+/CD4+/CD25+/CD127dull) counts by FACS analysis was observed in the elderly than young-onset LN (p=0.60, Figure 2).

Conclusion: This study suggests that elderly-onset LN may have better renal prognosis than young-onset LN. Increasing number of peripheral Treg in the elderly-onset LN indicate that alteration of immune system by aging may influence the results. Adequate sample size and a longer period of observation may be required to verify the results.

Disclosure: K. Hiramoto, Mitsubishi Tanabe Pharma Corporation Sohyaku, 2; H. Hanaoka, Mitsubishi Tanabe Pharma Corporation Sohyaku, 2; J. Kikuchi, Mitsubishi Tanabe Pharma Corporation Sohyaku, 2; S. Saito, Mitsubishi Tanabe Pharma Corporation Sohyaku, 2; H. Takei, Mitsubishi Tanabe Pharma Corporation Sohyaku, 2; T. Oshige, Mitsubishi Tanabe Pharma Corporation Sohyaku, 2; N. Seki, Mitsubishi Tanabe Pharma Corporation, 3; H. Tsujimoto, Mitsubishi Tanabe Pharma Corporation, 3; Y. Kaneko, Mitsubishi Tanabe Pharma Corporation Sohyaku, 2; T. Takeuchi, Mitsubishi Tanabe Pharma Co., 2, 8, Mitsubishi Tanabe Pharma Corporation, 2, 5, 8.

To cite this abstract in AMA style:

Hiramoto K, Hanaoka H, Kikuchi J, Saito S, Takei H, Oshige T, Seki N, Tsujimoto H, Kaneko Y, Takeuchi T. Newly Diagnosed Lupus Nephritis in Elderly Predicts Good Renal Outcome: A Distinct Disease Subset from Young-onset Lupus Nephritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/newly-diagnosed-lupus-nephritis-in-elderly-predicts-good-renal-outcome-a-distinct-disease-subset-from-young-onset-lupus-nephritis/. Accessed .

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