36 Evaluation of relapse rate and life prognosis after induction therapy in proliferative and membranous lupus nephritis

Abstract

Background Systemic lupus erythematosus (SLE) is a complex autoimmune disorder with a broad spectrum of clinical and immunologic manifestations, among which lupus nephritis (LN) is the most common cause of morbidity and mortality. Here we evaluated the relapse rate and life prognosis after induction therapy in proliferative and membranous LN. Methods One hundred fifty-one cases who underwent renal biopsy at our hospital and community hospitals from 1993 to 2016 were enrolled in this study. We retrospectively analyzed the complete response (CR) rate at 6 and 12 months after induction therapy and evaluated the predictive factors for CR, relapse rate and life prognosis in proliferative and membranous LN. Results In 140 cases, we were able to examine the therapeutic response, relapse rate and life prognosis at 6 and 12 months after therapy was introduced. Most of the patients were female (84.3%). The median age at onset of LN was 34.0 years (interquartile range [IQR] 25.345.0 years), and the disease duration of SLE was 42 months (IQR 2.0121.0 months). The median follow-up duration after renal biopsy was 96 months (IQR 44.0168.0 months). The renal pathology of 99 (70.7%) patients was classified as ISN/RPS Class III or IV, and 41 (29.3%) patients were ISN/RPS Class V. Thirty-five patients (35.4%) in Class III or IV and 41 patients (29.3%) in Class V achieved CR at 6 months, and 50 patients (50.5%) in Class III or IV and 22 patients (53.7%) in Class V achieved CR at 12 months. Multivariate analysis showed that lower index of chronicity as assessed by the NIH histological scoring system in Class III or IV, and neutrophil infiltration and CH50 in Class V were predictive factors for achieving CR at 12 months. Kaplan-Meier analysis showed that relapse rate and life prognosis were not different between proliferative and membranous LN. Conclusions Our results suggested that the predictive factors for CR at 12 months after induction therapy were lower index of chronicity in class III or IV and neutrophil infiltration and CH50 in Class V. In general, proliferative LN is more immunologically active than membranous LN, however there were no difference in the achieving CR at 6 and 12months after induction therapy, the relapse free period and life prognosis between proliferative and membranous LN.We need to closely follow up of therapeutic response and life prognosis of membrane LN as well as proliferative LN. Funding Source(s): None