Renal response at 2 years post biopsy to predict long-term renal survival in lupus nephritis: a retrospective analysis of the Hopkins Lupus Cohort. Issue 1 (29th August 2022)

• Record Type: Journal Article
• Authors: Cooper Blenkinsopp, Selin; Fu, Qinggong; Green, Yulia; Madan, Anuradha; Juliao, Patricia; Goldman, Daniel W; Roth, David A; Petri, Michelle A
• Is Part Of: Lupus science & medicine. Volume 9:Issue 1(2022)
• Publication Date: 2022-08-29
• Subjects: lupus erythematosus, systemic -- lupus nephritis -- outcome assessment, health care -- autoimmune diseases; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1136/lupus-2021-000598
• Languages: English
• ISSNs: 2398-8851

Abstract

Abstract : Objective: This retrospective analysis evaluated the prognostic value of renal response status 2 years after biopsy-proven lupus nephritis (LN) for the prediction of long-term renal outcomes. Methods: Eligible patients with SLE as per American College of Rheumatology or Systemic Lupus International Collaborating Clinics criteria and biopsy-proven class III, IV, V or mixed LN were identified from the Hopkins Lupus Cohort, and categorised into binary renal response categories (modified primary efficacy renal response (mPERR) or no mPERR at 2 years post biopsy). These categories were defined by a modified version of the Belimumab International Lupus Nephritis Study (BLISS-LN) protocol using urine protein:creatinine ratio (≤0.7 g/day) and estimated glomerular filtration rate (≥60 mL/min/1.73 m 2 or ≤20% below the baseline value) criteria. Long-term renal survival (defined as survival without end-stage renal disease (ESRD) or death) and chronic renal insufficiency-free survival were assessed in Kaplan–Meier plots with log-rank test and covariate-adjusted Cox proportional hazards models. Results: Of the 173 eligible patients, 91.3% were female; the mean (SD) age at biopsy was 36.2 (11.8) years. At 2 years post biopsy, 114 (65.9%) patients achieved mPERR. These patients showed a lower risk of ESRD/death and chronic renal insufficiency in the follow-up period (HR (95% CI) 0.33 (0.13 to 0.87), p=0.0255; and HR (95% CI) 0.26 (0.14 to 0.47), p<0.0001, respectively). Conclusions: The 2-year post-biopsy renal response status, defined per 2019-updated BLISS-LN criteria, has prognostic value for long-term renal survival and lower risk of chronic renal insufficiency in patients with LN.