Background and aims The aim of this study is to assess the prevalence of prolonged remission in patients with lupus nephritis (LN) and its relationship with damage accrual.

Methods 318 patients diagnosed with LN between 1990 and 2015 were included in the study. We defined remission as prolonged when lasting ≥5 consecutive years. (proteinuria ≤0,03 g/L and serum creatinine ≤133,6 µmol/L) Three levels of remission were defined using the SLE Disease Activity Index-2000 (SLEDAI-2K): complete remission: no disease activity in corticosteroid-free and immunosuppressant-free patients; clinical remission off corticosteroids: serologically active clinical quiescent (SACQ) disease in corticosteroid-free patients and clinical remission on corticosteroids: SACQ disease in patients taking prednisone 5–10 mg/24 hour. Damage was measured by the SLICC/American College of Rheumatology Damage Index (SDI).

Results 318 patients (293 women) fulfilled inclusion criteria. During the 10 year follow-up, 52 patients (16,35%) achieved prolonged complete remission, 107 (33,65%) prolonged clinical remission off corticosteroids and 114 (35,85%) prolonged clinical remission on corticosteroids. SDI increased more frequently in unremitted than in remitted patients (p<0,05); SDI median increase was higher in unremitted than in remitted patients. At multivariate analysis, unremitted disease and high-dose corticosteroid intake were risk factors for damage accrual.

Conclusions Patients with prolonged remission was associated with a better outcome in terms of damage accrual.