Immunosuppressive Treatment for Lupus Nephritis: Long-Term Results in 178 Patients

Abstract

Lupus nephritis is one of the most severe Systemic Lupus Erythematosus features, defining treatment modality and prognosis. Our retrospective study, including 178 patients treated for lupus nephritis during 23 years with mostly cyclophosphamide-based initial regimens followed by azathioprine or mycophenolic acid, demonstrates 84.8% of renal response with 19.2% of flares, 15-year patient survival 78.7% and kidney survival 76.3%, and low damage accrual. Both patient and kidney survival significantly differ for subgroups that achieved complete or partial renal response and nonresponders: patient 15-year survival 95% versus 65% versus 35%; kidney 15-year survival 100% versus 58% versus 0%, respectively. 51% (24 out of 47) of patients evaluated at the end of the study period sustained complete renal response; however, only 9 of them had 0 disease activity according to SELENA SLEDAI scale, while 13 patients had scores 2–4 due to the serological abnormalities only. We conclude that (1) initial treatment with cyclophosphamide followed by azathioprine is effective and can be used in agreement with International Guidelines until the evidence for biological treatments benefits becomes available; (2) complete and even partial renal response have positive prognostic value, and failure to achieve renal response negatively influences kidney and patient survival; (3) the validity of complete renal response in SLE is questioned by the absence of conventional definition of SLE remission.

Long‐term renal outcomes in multi‐ethnic Southeast Asians with lupus nephritis: a retrospective cohort study

“…The results of this study were consistent with other studies that also identified baseline renal function, 13,14 chronicity index, 29 remission 30,31 and relapse 12 to affect long-term renal survival. The latter may explain why one-tenth of our patients eventually developed progressive CKD, despite high remission rates of nearly 97%.…”

Remission and long-term outcomes of proliferative lupus nephritis: retrospective study of 96 patients from Saudi Arabia

“…17,19-26 However, only a few studies have looked at the value of partial remission with regard to long-term outcomes. 17,27,28 We aim in this study to examine the rate of short-term remission (6 months) to standard of care induction treatments, and study its predictors and effect on long-term renal outcomes in Saudi patients with PLN.…”