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LP-129 Lupus low disease activity state as an attainable and complementary target for lupus nephritis
  1. Chak Kwan Cheung,
  2. Shirley Chiu Wai Chan and
  3. Chak Sing Lau
  1. Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital and the University of Hong Kong, Hong Kong


Background Lupus nephritis (LN) affects up to 60% of patients with systemic lupus erythematosus. Complete renal response (CRR) at 12 months is recommended as a treatment target. Remission or low disease activity in extra-renal domains also contributes to one of the important treatment goals. This study evaluated the usefulness of Lupus Low Disease Activity State (LLDAS) as a treatment target in LN.

Methods Patients with a biopsy-proven active LN during the period of 2010–2020 were included. CRR was defined as proteinuria ≤0.5g/day (or equivalent) and normal estimate glomerular filtration rate (eGFR); partial renal response (PRR) was defined as a reduction of proteinuria by ≥50% with near-normal eGFR. The attainment of CRR, PRR, and LLDAS was evaluated at 12 months post-treatment. LN relapse was defined as worsening of proteinuria/serum creatinine and confirmed activity in repeat renal biopsy. The frequency of relapse was evaluated in patients who have achieved ≥50% proteinuria reduction to sub-nephrotic range post-treatment.

Results 143 LN patients were included with a median follow-up duration of 10.4 years. Most patients (74%) had class III/IV (±V) histological subtypes (table 1). At 12 months, 57(40%), 14(10%) and 69(48%) patients achieved CRR, PRR and LLDAS, respectively. Among 136 patients who achieved ≥50% proteinuria reduction to sub-nephrotic range, 30(22%) patients developed LN relapse after a median 2.98 years. CRR/PRR and LLDAS at 12 months were independent negative predictors of LN relapse. The risk of LN relapse was lowest among patients who achieved both LLDAS and CRR/PRR at 12 months (figure 1).

Conclusions LLDAS is an attainable target in LN and is associated with a lower risk of relapse. This study advocates the potential role of LLDAS as a complementary target to renal response in LN patients.

Abstract LP-129 Figure 1

CRR=complete renal remission; LLDAS=lupus low disease activity state; NR=no response; PRR=partial renal response

Abstract LP-129 Table 1

C3=complement 3; C4=complement 4; CKD=chronic kidney disease; dsDNA=double stranded DNA; eGFR=estimated glomerular filtration rate; RNP=ribonucleoprotein; Sm=smith; UPCR=urinary protein-creatinine ratio; 24huP= 24-hour urine protein. eGFR calculated by MDRD formula

  • Lupus Nephritis
  • Complementary Target

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