CLINICAL PROFILES AND OUTCOMES OF PURE VERSUS MIXED PROLIFERATIVE AND MEMBRANOUS LUPUS NEPHRITIS: A STUDY FROM A TERTIARY CENTER

PV201 / #334 Poster Topic: AS23 - SLE-Diagnosis, Manifestations, & Outcomes Background/Purpose Lupus nephritis (LN) represents one of the most severe and complex complications of systemic lupus erythematous (SLE), affecting a substantial proportion of patients. This study aims to describe the clinical profiles and outcomes of 4 different classes of LN in a diverse patient cohort, with the goal of identifying potential demographic, laboratory and clinical characteristics associated with poorer outcomes. Methods We conducted a retrospective review of the medical records for 254 patients with LN confirmed by renal biopsy at Houston Methodist Hospital between 2016 and 2023. A subset of patients with pure and mixed proliferative and membranous LN (class III or IV + class V according to the 2003 ISN/RPS classification criteria) were included. Continuous variables are presented as means with standard deviations, and categorical variables as frequencies and percentages. Differences in continuous and categorical variables were analyzed using the chi-square, Fisher’s exact test or analysis of variance (ANOVA), as appropriate. Kaplan-Meier analysis was applied to evaluate dialysis-free survival. Data processing and analysis were conducted using GraphPad Prism version 10.3.1. Results We identified 93 patients with LN across the 4 classes. The demographic and clinical characteristics are summarized by each class in Table 1. The mean age across all patients was 36.6 years, and 81.7% of the cohort were female. In terms of race, non-Hispanic Black patients represented the largest proportion, accounting for 44.1% of the cohort, with the highest representation in the class III+V group (50%). Laboratory testing revealed that patients with class IV+V were more likely to have higher serum creatinine (2.5 mg/dL), lower eGFR (42.5 ml/min), lower complement C3 level (61.4 mg/dL) and worse proteinuria (UPCR 4211.3 mg/g) compared to the other groups. Interestingly, 6 individuals in the cohort were found to have a negative antinuclear antibody (ANA) test. The mean SLEDAI-2K score was 13.0 in all the patients, indicating active SLE disease, with the highest score (21.9) observed in class III. The most used immunosuppressive therapies were glucocorticoids (89.9%) and mycophenolate mofetil (68.8%), followed by hydroxychloroquine (62.4%), cyclophosphamide (16.1%), belimumab (5.4%), voclosporin (3.2%) and rituximab (2.2%). Overall, a greater proportion of patients were under the care of a nephrologist compared to a rheumatologist (89.2% vs 65.5%). In the total study population, the mean follow-up duration was 39.9 months. During the follow-up period, only 22.6% of the patients achieved complete remission, with the highest rate observed in class IV (28%) and the lowest in class IV+V (9.1%). A total of 23.7% of patients required dialysis, with the highest incidence found in class IV+V (36.4%); however, the time-dependent incidence did not show a statistically significant difference (p=0.6) (Figure 1). The overall all-cause mortality rate was 5.4%. Table 1. Figure 1. Conclusions In our study, patients diagnosed with class IV+V LN often presented with more severe disease characteristics, such as lower eGFR, lower remission rates and greater dialysis need. Therefore, aggressive treatment strategies are necessary, and dual or triple therapy should be considered for this higher-risk group. This is particularly crucial for younger, female, and non-Hispanic Black patients, who tend to have worse outcomes compared to their counterparts. Hydroxychloroquine was significantly underutilized in this cohort. Hence, our study underscores the importance of a collaborative treatment approach that integrates both nephrology and rheumatology.

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