Abstract: TH-PO655
Kidney and Patients Outcomes of Pure Lupus Nephritis: A Nationwide Analysis in Japan
Session Information
- Lupus Nephritis: Clinical, Outcomes, and Therapeutics
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Ikeuchi, Hidekazu, Gunma Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Maebashi, Gunma, Japan
- Imai, Yoichi, Gunma Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Maebashi, Gunma, Japan
- Maruyama, Shoichi, Nagoya Daigaku, Nagoya, Aichi, Japan
- Sugiyama, Hitoshi, Kawasaki Ika Daigaku, Kurashiki, Okayama, Japan
- Sato, Hiroshii, Tohoku Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Sendai, Miyagi, Japan
- Yokoyama, Hitoshi, Kanazawa Daigaku, Kanazawa, Ishikawa, Japan
- Hiromura, Keiju, Gunma Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Maebashi, Gunma, Japan
Background
Pure membranous lupus nephritis (MLN) generally exhibits a more favorable renal prognosis compared to proliferative lupus nephritis (LN). However, clinical data on pure MLN are limited. This study aims to clarify the renal and patient outcomes, as well as the associated risk factors, of pure MLN in Japan.
Methods
Among 489 adult patients who underwent renal biopsy and were registered as having LN in the Japan Renal Biopsy Registry (J-RBR) from 2007 to 2012, 90 patients with pure MLN were examined in this study. Renal endpoint was defined as a 50% increase in serum creatinine. Risk factors were determined using univariate and multivariate Cox proportional hazards analysis.
Results
The average age at the time of renal biopsy was 43.7±15.1 years, with females comprising 87.8% of the cohort. The average eGFR and urinary protein levels were 90.2±32.7 mL/min/1.73m<span style="font-size:10.8333px">2</span> and 3.36±0.16 g/gCr, respectively. Nephrotic syndrome (NS) was observed in 42.2% of patients. Glucocorticoids (GC) were administered to 84 patients (93.3%), with an average initial dose of 33.5 ± 18.1 mg/day, and 27 patients (30.3%) were treated with GC alone. Tacrolimus was used in 38 patients (42.2%), and cyclosporin A in 14 patients (15.6%). During the median observation period of 62.4 months (IQR, 50.5–81.8), 11 patients (12.2%) reached a renal endpoint and 7 patients (7.8%) died. The 5-year renal and patient survival rates were 90.3% (95% CI, 81.3–95.0) and 93.8% (95% CI, 85.6–97.4), respectively. Univariate analysis showed that eGFR <45 and NS were associated with poor renal outcomes (HR 6.810, P=0.005 and HR 3.789, P=0.049, respectively). Univariate analysis also showed that age ≥45 and eGFR <45 were associated with patient death (HR 6.584, P=0.081 and HR 13.05, P=0.001, respectively). Multivariate analysis revealed that eGFR <45 was an independent risk factor for both poor renal outcomes (HR 5.686, P=0.015) and patient death (HR 8.633, P=0.008).
Conclusion
During a median 5-year observation period, some patients with pure MLN experienced a decline in renal function or death. An eGFR <45 at the time of renal biopsy was identified as a risk factor for both poor renal outcomes and decreased patient survival.
Funding
- Private Foundation Support