SP176
ASSOCIATIONS OF RENAL FUNCTION DECLINE IN LUPUS NEPHRITIS- A SINGLE CENTRE EXPERIENCE OF OVER 12 YEARS

INTRODUCTION AND AIMS: Lupus nephritis is a common manifestation of systemic lupus erythematosus (SLE), presenting at varying stage of this condition. Outcomes can vary depending on presentation and histologic variants despite standard management.This study aims to review the clinical characteristics and factors associated with renal function decline in a cohort of lupus nephritis patients of our centre.

METHODS: A list of all biopsy-proven lupus nephritis patients followed up in our centre between January 2005 and August 2017 was collected. At baseline (biopsy date), data gathered included demographics, blood results and histopathological characteristics. Follow up data on management strategies, blood results, and mortality data were collected till study endpoints (end-stage renal disease (ESRD), lost to follow-up, death and till the end of August 2017). Cox regression analysis was performed to study the association of clinical and histological factors to renal end points (doubling of serum creatinine or reaching ESRD).

RESULTS: We had a sample of 44 patients with biopsy-proven lupus nephritis over this 12.5 years. The median age of our sample was 34, with the majority being females (75%) and Caucasians (61.4%). At baseline, 48% of our group had a history of hypertension with a median blood pressure with treatment being 134/80. 88.6% of our cohort were on renin-angiotensin system blockers. Median urine protein creatinine ratio was 235 g/mol with serum creatinine 80 umol/l and haemoglobin 120 g/l. On biopsy, the predominant classes (ISN/RPS) of lupus nephritis included class III (25%), class IV (31.8%) and Class V (27.28%). Standard first-line treatment included steroids, mycophenolate mofetil (MMF) and cyclophosphamide. Drugs used in induction regime are listed in table-1. In a median follow-up of 73 months, 16 (36.4%) reached renal end-point (4 reached ESRD and 12 had a doubling of serum creatinine). 5 (11.4%) deaths were reported. A univariate Cox regression model showed a strong association of high baseline creatinine with renal end-points (HR: 1.01; CI (1.00-1.03); p=0.001). Among histological variants, the presence of global sclerosis and IFTA showed a non-significant trend towards renal endpoints. (Table-2)

CONCLUSIONS: With our current induction regime, renal remission was achieved in 91% of patients. Lupus class IV and the presence of global sclerosis and IFTA showed some positive signals for renal function decline, although a strong association of histological variants was not established.