SHORT TERM OUTCOMES OF LUPUS NEPHRITIS

Introduction:

The incidence of Lupus Nephritis (LN) in Systemic lupus erythematosus (SLE) patients is 20%–60%, depending on the study population. LN patients with complete clinical response to treatment had 92% kidney survival at ten years compared to 43% in partial responders and 13% in non-responders. There is paucity of data on the renal outcome of proliferative forms of LN to various induction regimens from the southern part of India. In this study, we aimed to compare the efficacy of three induction regimes, the National Institute of Health (NIH) regimen, the European Lupus Nephritis Trial (ELNT) regimen, and the Mycophenolate Mofetil (MMF) regimen, in proliferative lupus nephritis in our population.

Methods:

This single-center observational study was conducted in patients with biopsy-proven class III, IV, III+V, or IV+V LN. Study participants were started on one of the three regimens: the NIH, the ELNT, or the MMF, depending on the disease activity, age, risk of infertility, compliance, prior exposure to cyclophosphamide, and the patient's willingness. Patients were followed up every two weeks through week 24. Baseline investigations were performed at the time of diagnosis, including urine examination, complete blood counts, renal function tests, serum albumin, urine protein creatinine ratio (uPCR), ANA, anti-dsDNA, and complement levels. Complete blood counts, renal function tests, and uPCR were performed at each follow-up. The renal response was assessed after 24 weeks, according to the 2021 KDIGO criteria for LN.

Results:

Baseline characteristics of the study population are depicted in Table 1.

Among the study participants, 12(24%) were treated with the NIH regimen, 18(36%) with the ELNT regimen, and 20(40%) with oral MMF as an induction regimen.

At the end of 24 weeks, 83.34% achieved complete remission in the NIH group, and 16.67% achieved partial remission. In the ELNT group, 61.1% achieved complete remission, while 38.89% achieved partial remission. In the MMF group, 80% achieved complete remission,10% achieved partial remission, and 10% didn’t achieve any remission.  No statistically significant difference in response was found between the three induction treatment groups (P=0.114). 

The occurrence of intercurrent infections during treatment was 16.67% in the NIH group, 22.2% in the ELNT group, and 20% in the MMF group. Although infections were low with the NIH regimen, the difference was not statistically significant between the groups (P=0.697). Our study population had a better response to initial treatment, possibly due to earlier diagnosis and treatment, as indicated by lower chronicity indexes in renal biopsy. Although the mean proteinuria and activity index in the MMF group were not statistically different from the other groups, they were relatively low. These factors could have influenced the outcome in the MMF group.

Conclusions:

This study demonstrates that in patients with proliferative LN, the NIH regimen, the ELNT regimen, and the MMF regimens are equally effective with similar safety profiles in inducing remission in our population. This study is limited by being single-centered and conducted within a single ethnic group, with analysis restricted to the induction phase of treatment alone. A larger, multicenter trial with extended follow-up is needed for more robust evidence and long-term outcome assessment.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.