Lupus Nephritis in End-stage Renal Disease Patients Declines

Cases of recurrent lupus nephritis in lupus patients undergoing transplant for renal disease are on the decline, according to a new study. 

Researchers reviewed medical records of 38 patients (mean age at baseline, 42 years; 89% female; 89% black) with end stage renal disease secondary to lupus nephritis who received renal transplants at one center between 2006 and 2017. Median previous time on dialysis was four years; 80% of patients received hemodialysis and 31% received living donor transplantation. 

How to interpret a renal biopsy in lupus nephritis #ACR18 pic.twitter.com/0jInj101G3

— Aarat Patel, MD (@PatelAarat) October 20, 2018

In total, 11% (n = 4) of patients had lupus nephritis recurrence, diagnosed by biopsy; during a median follow-up of 1,230 days, 26% (n = 10) of patients had graft loss or died. Recurrent lupus nephritis was a risk factor for graft loss or death (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 0.65-15.24) compared with patients who did not have recurrence. 

All patients underwent a posttransplant immunosuppressive regimen consisting of tacrolimus and mycophenolate mofetil instead of cyclosporine and azathioprine in addition to prednisone, a significant difference when comparing with older cases, when recurrence rates were higher, according to the researchers. 

Dr Appel’s approach for maintenance therapy in Lupus nephritis. Great pearls. #acr18 pic.twitter.com/UPVumlwUDm

— Ara Dikranian (@RumorDoc) October 20, 2018

Debenda Pattanaik, MBBS, MD, lead study author of “Recurrence of Lupus Nephritis in Renal Transplant Recipients,” presented the findings at the American College of Rheumatology annual meeting. Dr. Pattanaik said graft loss secondary to recurrence of lupus should not deter caregivers from recommending renal transplants. Lupus patients with end-stage renal disease “can have as good an outcome” as those with hypertension or diabetes, according to Dr. Pattanaik. 

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All-Cause and Cause-Specific Mortality Trends of End-Stage Renal Disease due to Lupus Nephritis from 1995 to 2014 

Efficacy of Belimumab for active lupus nephritis in a young Hispanic woman intolerant to standard treatment: a case report 

Lupus nephritis: An update on treatments and pathogenesis 

Sources: MedPage Today, American College of Rheumatology