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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
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Lupus Nephritis Outcomes after Stopping Immunosuppression
Fahidah Alenzi1, Oier Ateka-Barrutia2, Chee Ken Cheah3
1Internal Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia.
Journal of Clinical Medicine
|April 27, 2024
Summary
Discontinuing immunosuppression for lupus nephritis (LN) is often safe, with most patients maintaining remission. However, certain factors like high creatinine and anti-Smith antibodies increase relapse risk.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Immunosuppression (IS) is standard for lupus nephritis (LN).
- Outcomes after IS discontinuation in LN patients are not well-defined.
- This study evaluates LN patient outcomes post-IS cessation.
Purpose of the Study:
- To assess the clinical outcomes of lupus nephritis patients after stopping immunosuppressive therapy.
- To identify predictors of relapse following immunosuppression withdrawal in LN.
Main Methods:
- Retrospective analysis of clinical and laboratory data from 45 LN patients who ceased IS therapy.
- Defined LN flare by a twofold increase in serum creatinine and proteinuria.
- Analyzed patient demographics, LN class, IS treatment, and outcomes (stable vs. flare).
Main Results:
- Most patients (71.1%) maintained remission after IS discontinuation.
- 28.9% of patients experienced a relapse.
- Anti-Smith antibodies (anti-Sm) and elevated creatinine post-cessation were associated with higher relapse rates.
Conclusions:
- Many lupus nephritis patients can safely discontinue immunosuppression while maintaining remission.
- Elevated creatinine, proteinuria, low complement, and anti-Sm antibodies predict a higher risk of flares after IS withdrawal.
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