THU0273 EVALUATION OF RELAPSE RATE AND LIFE PROGNOSIS AFTER INDUCTION THERAPY IN PROLIFERATIVE AND MEMBRANOUS LUPUS NEPHRITIS

Abstract

Background The most common cause of morbidity and mortality in systemic lupus erythematosus (SLE) is lupus nephritis (LN). Renal flares are disadvantageous to the renal function of patients with severe LN, and the flares contribute to morbidity in patients with SLE. The reported incidence of renal flares has varied with the populations studied, the distribution of histological classes of LN, the treatment administered and the definitions of renal flare. Objectives Here we evaluated the relapse rate and life prognosis after induction therapy in proliferative and membranous LN. Methods We retrospectively analyzed the cases of 151 patients who underwent renal biopsy at our hospital and community hospitals from 1993 to 2016. We determined 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 We were able to examine the therapeutic response, relapse rate and life prognosis at 6 and 12 months after therapy was introduced in 140 cases. Most of the patients were female (84.3%). The median age at LN onset was 34.0 years (interquartile range [IQR] 25.3–45.0 years), and the disease duration of SLE was 42 months (IQR 2.0–121.0 months). The median follow-up duration after renal biopsy was 96 months (IQR 44.0–168.0 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%) were Class III or IV, and 17 patients (41.5%) in Class V achieved a CR at 6 months. Fifty patients (50.5%) in Class III/IV and 22 patients (53.7%) in Class V achieved a CR at 12 months. A multivariate analysis showed that a lower index of chronicity as assessed by the NIH histological scoring system in Class III/IV, and neutrophil infiltration and CH50 in Class V were predictive factors for achieving a CR at 12 months. A Kaplan-Meier analysis showed that the relapse rate and life prognosis were not different between proliferative and membranous LN. Conclusion Our results suggest that the predictive factors for a CR at 12 months after induction therapy are a lower index of chronicity in class III/IV and neutrophil infiltration and CH50 in Class V. In general, proliferative LN is more immunologically active than membranous LN, but we observed no significant differences in the achievement of a CR at 6 or 12 months after induction therapy, the relapse-free period, of life prognosis between proliferative and membranous LN. The therapeutic response and life prognosis of membranous LN as well as proliferative LN should be monitored closely.