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Background Repeated renal flares in lupus nephritis (LN) have been associated with worse long-term kidney function. This study aimed to assess the impact of repeated LN flares in response to therapy, kidney, and patient prognosis. Methods All patients from a biopsy-proven LN cohort between 2 008 and 2 018 were segregated into three groups according to the number of LN flares when they entered our cohort: first LN flare, second LN flare, or third LN flare. The following outcomes were evaluated by unadjusted and adjusted time-to-event analyses: complete and partial response, disease relapses, progression to decline of 30% of the eGFR, doubling of serum creatinine, end-stage kidney disease, and patient survival. Results A total of 441 patients were included: 257 (58%) in their first LN flare, 102 (23%) in their second LN flare, and 82 (19%) in their third LN flare. There were significant differences in LN flare presentation in age, eGFR, serum albumin, pyuria, and hematuria among groups. The NIH chronicity indices and the percentage of patients with vascular lesions were higher in groups at progressive LN flares. In the adjusted analyses, complete and partial response rates decreased, as well as kidney and patient survival, at a progressive number of LN flares. No differences in the dynamic course of all surveillance laboratory parameters were observed in the first year after initial therapy among LN flare groups. Conclusions A progressive number of LN flares is associated with a lower response to therapy and an adverse prognosis for kidney function and patient survival.

Objectives To characterize the clinical presentation and outcomes of lupus nephritis (LN) in a Hispanic cohort from Mexico. Methods We studied 440 subjects with systemic lupus erythematosus and biopsy-proven LN followed for >36 months. We obtained demographic, clinical, laboratory, histopathological, and treatment variables. All outcomes were analysed by survival analysis and included response to therapy, renal relapses, progression of kidney disease (decline in eGFR ≥ 30%, doubling of serum creatinine, end-stage kidney disease), and patient survival. Results The median age of the study cohort was 29 years (IQR 23–37), and 96% were female. The median eGFR at inclusion was 81 mL/min/1.73m2 (IQR 48–118), and 24 h-uPCR was 3.4 g/g (IQR 1.9–5.6). Mixed class LN (III/IV+V) was the most frequently observed (69%). Over a median follow-up of 79 months, complete response rates were 22.3%, 40.5%, and 51.6%, at 6-, 12-, and 24-months, respectively. Renal relapse rates were 32.3% and 50.6% at 3- and 5-years. By 3- and 5-years, 20.7% and 31.4% had decline in eGFR ≥30%, 14.4% and 22.5% doubled their serum creatinine, and 9.1% and 17.7% progressed to ESKD. The factors associated with loss of kidney function were age, eGFR at presentation, the histologic chronicity index in the kidney biopsy, and the type of response to therapy. Patient survival was 98.2% and 97.1% at 3- and 5-years. Conclusion Although the response to treatment and patient survival in this Latin American cohort is comparable to that observed in other regions, there is still a high rate of renal relapses and progression to decline in kidney function.

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