Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Effect of sustained clinical remission on the risk of lupus flares and impaired kidney function in patients with lupus nephritis,” published in the January 2024 issue of Nephrology by Gatto et al.

In this retrospective study of biopsy-proven lupus nephritis (LN) patients, their objective was to evaluate the likelihood of sustained clinical remission (sCR) and explore its impact on disease flares and impaired kidney function (IKF). Sustained clinical remission was defined as clinical-SLEDAI-2K=0 and eGFR>60ml/min/1.73m² lasting ≥1 year, while IKF was characterized by eGFR<60ml/min/1.73m² for more than three months.

Their analysis, involving 303 patients over a mean follow-up of 14.8 years, revealed that 84.8% achieved sCR, with the probability progressively increasing and reaching 90% at 15 years. Baseline age, hydroxychloroquine intake, and absence of arterial hypertension emerged as independent predictors of sCR. Among those achieving sCR, 55.3% experienced a lupus flare after a median of 3.6 years, while sCR persisted for a median of 9.5 years in the remaining patients. The probability of sCR persisting at 15 years was 38%, and the risk of lupus flares decreased with longer sCR duration. At the last observation, 18.81% of patients had IKF. Achievement of sCR and its duration were protective factors against IKF.

In conclusion, their findings underscore that sCR is an attainable goal in LN management, offering protection against IKF. Moreover, a more extended duration of sCR is associated with a higher likelihood of persistence and a reduced risk of SLE flares, shedding light on the importance of sustained clinical remission in the comprehensive care of lupus nephritis patients.

Source: sciencedirect.com/science/article/pii/S2468024924000172