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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Lupus nephritis (LN) represents one of the most severe manifestations of systemic lupus erythematosus (SLE), affecting approximately 40-60% of patients and significantly impacting long-term prognosis. Early recognition of high-risk features including advanced CKD at presentation, significant chronicity index, and prominent tubulointerstitial inflammation enables risk stratification and guides treatment intensification strategies to optimize long-term kidney.
a 24-year-old female with a one-year history of lupus nephritis who developed progressive kidney dysfunction and recurrent hypokalemia despite ongoing immunosuppressive therapy. The patient presented with generalized edema and was receiving mycophenolate sodium (Myfortic) 720 mg twice daily, slow-release potassium supplementation three times daily, and methylprednisolone 4 mg once daily. Clinical evaluation revealed chronic kidney disease (CKD) stage 4, indicating significant renal impairment with an estimated glomerular filtration rate between 15-30 mL/min/1.73m². Kidney biopsy demonstrated Class IV-G lupus nephritis with both active and chronic lesions (diffuse lupus nephritis A/C), characterized by diffuse global proliferative glomerulonephritis affecting more than 50% of glomeruli with mixed active inflammatory changes and chronic sclerotic features.
Studies demonstrate that coexisting tubulointerstitial inflammation and damage confer a 2.7-fold increased risk of CKD progression and portend worse kidney outcomes independent of glomerular classification. Presence of chronic lesions at diagnosis predicts increased risk of progression to end-stage kidney disease and incomplete response to immunosuppressive therapy.Management of Class IV lupus nephritis requires aggressive induction immunosuppression followed by prolonged maintenance therapy. Current guidelines recommend mycophenolate mofetil (MMF) or mycophenolic acid derivatives such as Myfortic at doses of 720 mg twice daily (1,440 mg total daily dose) as first-line induction therapy in combination with glucocorticoids. The optimal induction duration spans 3-6 months, with total treatment duration of at least 36 months to minimize relapse risk. However, patients with advanced CKD stage 4 at presentation face substantially worse prognosis, with kidney survival rates declining progressively as baseline renal function deteriorates. The patient also with recurrent hypokalemia that etiology likely involves autoimmune-mediated impairment of distal tubular potassium transport that requiring persistent potassium supplementation or mineralocorticoid antagonist therapy despite concurrent use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
This case illustrates the complex interplay between glomerular and tubulointerstitial pathology in lupus nephritis, the challenge of managing recurrent electrolyte abnormalities, and the importance of timely intervention in preventing progression to end-stage kidney disease
