Early achievement of complete renal response predicts good long-term renal outcome and low systemic damage in newly diagnosed lupus nephritis class III or IV

Abstract

Objective. To identify predictors of long-term renal prognosis after induction therapy in patients with newly diagnosed lupus nephritis class III or IV.

Methods. We retrospectively studied patients with newly diagnosed lupus nephritis class III or IV. We divided them into two groups according to the complete renal response (CR) status at 3 years after induction therapy. We compared baseline clinical characteristics, renal pathological findings, and time to achieve CR, and identified predictors. Patients were followed up for to 10 years to assess long-term systemic damage.

Results. Eighteen patients with CR and 9 with non-CR were included. There were no significant differences in baseline characteristics. Early CR, which was defined as achieving CR at 3 months after induction therapy, was significantly associated with maintaining CR at 3 years (p = 0.012). Patients with early CR less frequently had flare in systemic manifestation compared with those without over 10 years (p = 0.026). Deterioration of systemic damage was observed more often in non-early CR patients than early CR patients at 10 years (p = 0.029).

Conclusion. Achieving CR at 3 months after induction therapy may predict CR at 3 years, reduced organ damage, and a low incidence of disease flare for 10 years.

Keywords:

• Early complete renal response
• Lupus nephritis
• Systemic lupus erythematosus

Conflict of interest

H.H. has received consulting fee from Astrazeneca. Y.K. has received lecture fees from AbbVie, Eisai, Chugai, Bristol-Myers, Astellas, Mitsubishi Tanabe, Pfizer, Janssen, and UCB. T.T. has received grants from Abbott, Astellas, Bristol-Myers, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, Pfizer, Sanofi, Santen, Takeda, Teijin, AbbVie, Asahi Kasei, and Taisho Toyama; lecture fees from Abbott, Bristol-Myers, Chugai, Eisai, Janssen, Mitsubishi Tanabe, Pfizer, Takeda, Astellas, and Daiichi Sankyo; and consulting fees from AstraZeneca, Eli Lilly, Novartis, Mitsubishi Tanabe, Asahi Kasei, AbbVie, and Daiichi Sankyo.