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Abstract Number: 2799

Outcomes in Patients with Early and Delayed Onset Lupus Nephritis

Roaa ALJohani1, Dafna D. Gladman1, Jiandong Su1 and Murray Urowitz2, 1Rheumatology, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, 2Medicine, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Lupus nephritis

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Session Information

Date: Tuesday, November 15, 2016

Session Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster III: Biomarkers and Nephritis

Session Type: ACR Poster Session C

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

Background/Purpose:  To compare disease characteristics in patients with early and delayed onset of lupus nephritis(LN) and their outcomes after 5 years of follow-up.

Methods:  Patients with LN were identified from a prospective cohort of single lupus center. Only patients who entered the cohort within 2 years from SLE diagnosis were considered. Patients who developed LN within 3 years of diagnosis (Early LN group) were compared with patients in whom LN diagnosed after 3 years of SLE diagnosis (Delayed LN).Five outcomes were evaluated: complete renal remission (CR, normalization of all of RBCs, protein, casts, pyuria), partial renal remission (PR, 50% improvement),renal flares (Increase in any of renal SLEDAI-2K score after CR), renal failure, renal damage progression (SDI) and death. Outcomes were assessed by Cox proportional hazard regression analyses.

Results: A total of 277(85%)Early LN patients (83.3% female,61%caucasian) and 49(15%) Delayed LN patients(87.8% female, 65.3% Caucasian)were included.

Variables at LN

Early

(N= 277)

Delayed

(N=49)

P value

Age*

33.55 ± 13.03

41.97 ± 15.17

<0.001

Disease duration*

0.68 ± 0.69

7.78 ± 4.61

 0.001>

SLEDAI-2k score*

12.71 ± 8.59

9.47 ± 6.93

0.013

SLEDAI-2k non renal score*

6.47 ± 6.32

4.57 ± 3.97

0.043

SDI Score*

0.15 ± 0.48

0.82 ± 1.07

<0.001

Low Complements †

155 (56.2%)

25 (51.0%)

0.505

Anti DNA †

152 (59.1%)

27 (55.1%)

0.599

High Serum creatinine†

55 (19.9%)

2 (4.1%)

0.007

GCS use

255 (92.1%)

39 (79.6%)

0.007

Antimalarial use

138 (49.8%)

33 (67.3%)

0.024

IS use

177 (63.9%)

27 (55.1%)

0.241

*Mean ± SD; †n(%); GCS: Glucocorticosteroid; IS: immunosuppressive

At nephritis, Early LN patients had more active disease but less damage accrual. After 5 years of follow-up, CR was higher in Early LN group. SDI scores increased significantly in the early LN group. There were no differences in renal flares, renal failure or death. Multivariate regression analysis revealed that patients with higher SLEDAI-2K and SDI scores were less likely to achieve CR. Using GCS and IS increased SDI, whereas antimalarial use and high DNA levels were protective. Caucasian ethnicity, older age at diagnosis of LN, early onset of LN, high SDI scores, high SLEDAI-2K scores, low complement levels, and GCSuse, were associated with poorer survival, while the use of antimalarial and IS were protective. Older age at CR was the only factor predicting less renal flares.

Conclusion:  Patients with delayed development of LN had a milder disease course and more favorable outcomes than those with early LN.


Disclosure: R. ALJohani, None; D. D. Gladman, None; J. Su, None; M. Urowitz, None.

To cite this abstract in AMA style:

ALJohani R, Gladman DD, Su J, Urowitz M. Outcomes in Patients with Early and Delayed Onset Lupus Nephritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/outcomes-in-patients-with-early-and-delayed-onset-lupus-nephritis/. Accessed January 15, 2021.
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