RISK FACTORS FOR DE NOVO LUPUS NEPHRITIS IN NON-RENAL SLE PATIENTS TREATED WITH AZATHIOPRINE
Bibliographic record
Abstract
PV130 / #54 Poster Topic: AS15 - Lupus Nephritis-Clinical Background/Purpose Lupus nephritis (LN) is 1 of the most common, potentially organ threatening, and even fatal complications for patients living with systemic lupus erythematosus (SLE). The initial signs of lupus nephritis include persistent proteinuria > 0.5 g daily, microscopic hematuria with or without erythrocyte dysmorphism, cellular casts, and new-onset hypertension. The risk factors (eg, active extra-renal disease, male sex, smoking, and history of renal diseases) for LN were identified. Azathioprine (AZA) had been widely used for non-renal SLE and is 1 of the standard-of-care options for maintenance therapy for lupus nephritis. However, lupus nephritis develops even in patients already on immunosuppression. In this study, we attempted to identify the baseline risk factors for new LN flares in SLE patients receiving AZA for non-renal SLE. Methods In this retrospective, multicenter study, we identified SLE patients treated with azathioprine for non-renal manifestations. Individuals with previous or active LN at the AZA initiation were excluded. The demographics, systemic lupus erythematosus disease activity index-2K (SLEDAI-2K), and transient proteinuria with UPCR > 0.5 g/g for less than 1 month were identified. The LN flares were defined as either persistent proteinuria with UPCR > 0.5 g/g for 2 consecutive visits for more than 1 month or LN diagnosed on renal biopsy. The prognostic values of baseline SLEDAI score, serology (positive anti-dsDNA and low complement levels), active disease by organ domains, and transient proteinuria were analyzed. Results From 2006 to January 2023, 160 eligible patients were included in the analysis. 88% were female and the median age at enrollment was 37 (29-48) years. 96.9% patients received hydroxychloroquine concomitantly, and all were taking glucocorticoids. The SLEDAI score was 7.5 (4.0-11.0), and 5.6% patients had transient proteinuria at the time of AZA initiation. The median follow-up time was 6.1 (4.4-9.3) years. Through the observation period, LN flare occurred in 16% patients. The median time to LN flare was 4.4 (2.6-6.4) years. The LN flared patients had higher baseline SLEDAI score (10.5 vs. 6.0, p = 0.002), mucocutaneous disease (69% vs. 43%, p = 0.015), and transient proteinuria (27% vs. 1.5%, p < 0.001). The transient proteinuria at baseline was associated with decreased LN-free survival (Figure). On multivariable analyses, mucocutaneous (HR 2.88, p = 0.015), vasculitis (HR 6.81, p < 0.001), and transient proteinuria (HR 11.3, p < 0.001) were independent risk factors for LN flares (Table). Figure Table. Univariable and multivariable Cox regression analysis of baseline predictors for LN flare Conclusions In non-renal SLE patients treated with AZA, lupus nephritis flares were not uncommon. The baseline SLEDAI score, mucocutaneous disease, and vasculitis were associated with lupus nephritis development. The transient, low-level proteinuria was a strong predictor for lupus nephritis. Although low-level proteinuria might not be leading to renal biopsy, close monitoring and prompt diagnostic workup should be considered even in patients under immunosuppression.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".