Post-Biopsy renal response may predict Long-Term Survival in Lupus Nephritis patients

USA: When predicting the long-term renal survival in lupus nephritis patients, the 2-year post-biopsy renal response status may be a useful indicator (LN). Response may also signify a reduced risk of chronic renal insufficiency, as per the most recent revision of the Belimumab International Lupus Nephritis Study (BLISS-LN) criteria, states a  research published in the journal of Lupus Science & Medicine.

Depending on characteristics like age, gender, race, and ethnicity, lupus nephritis (LN), a prevalent and severe symptom of SLE, is present in 38% of patients at the time of SLE diagnosis and can develop in up to 70% of SLE patients over the course of the disease. A consistent and reliable assessment of treatments in LN clinical trials and the optimization of LN treatment in clinical practice would be made possible by the identification of early-stage predictors of long-term renal outcomes.

"The majority of research have employed the GFR and proteinuria level to define renal response; however, there is disagreement about the precise ratio and cutoff values for both outcome measures", the authors wrote.

The authors analyzed the predictive relevance of renal response status 2 years following biopsy-proven lupus nephritis (LN) for the forecasting of long-term renal outcomes.

Retrospective analysis was performed on the Hopkins Lupus Cohort to identify eligible patients with systemic lupus erythematosus (SLE), as determined by the American College of Rheumatology or Systemic Lupus International Collaborating Clinics criteria, and biopsy-proven class III, IV, V, or mixed LN. Then, depending on whether there was a modified primary efficacy renal response (mPERR) at the 2-year point or not, patients were divided into 2 binary renal response categories. Urine protein:creatinine ratio (uPCR; 0.7 g/day) and an estimated GFR (60 mL/min/1.73 m2 or 20% below the baseline value) criteria were used to determine categories by a modified version of the BLISS-LN technique. Kaplan-Meier plots and covariate-adjusted Cox proportional hazards models were used to assess the long-term renal survival, which was defined as patients who did not develop end-stage renal disease (ESRD) or face death. There were a total of 173 patients who qualified for inclusion; the mean age at biopsy was 36.2 years, and 91.3% of these patients were female. Immunosuppressive (IS) therapy was used in the 3 months prior to or 3 months following biopsy by the majority (82.7%).

Findings of the study:

• 114 patients (65.9%) had mPERR at 2 years after the biopsy.
• These patients demonstrated a decreased risk of ESRD/death and chronic renal insufficiency over the follow-up period (HR (95% CI) 0.33 (0.13 to 0.87), p=0.0255; and HR (95% CI) 0.26 (0.14 to 0.47), p0.0001, respectively).

When employed as an endpoint in real-world research, the mPERR status (responder vs. non-responder) after 2 years following biopsy has predictive value for the long-term renal outcomes of patients with LN, the researchers concluded.

REFERENCE

Cooper Blenkinsopp S, Fu Q, Green Y, et al Renal response at 2 years post biopsy to predict long-term renal survival in lupus nephritis: a retrospective analysis of the Hopkins Lupus Cohort Lupus Science & Medicine 2022;9:e000598. doi: 10.1136/lupus-2021-000598