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SAT0196 RENAL FLARE IN CLASS V LUPUS NEPHRITIS: INCREASED RISK IN PATIENTS WITH TUBULOINTERSTITIAL LESIONS

Background: Lupus nephritis leads to considerable morbidity and mortality in patients with systemic lupus erythematosus. Although membranous lupus nephritis has a better renal prognosis than proliferative lupus nephritis, progression to end-stage renal disease does occur. Renal flare is an independent predictor of renal prognosis in membranous lupus nephritis. Objectives: To investigate the risk factors of renal flare in patients with membranous lupus nephritis. Methods: Biopsy-proven pure membranous lupus nephritis patients diagnosed between January 1997 and September 2017 were studied. We assessed and compared the clinical and pathological parameters between patients who experienced renal flare and those who did not. To identify risk factors of renal flare, multivariable Cox proportional hazard regression analysis with stepwise backward elimination was performed. Results: Out of the 53 patients with pure membranous lupus nephritis, 17 patients (32.1%) experienced renal flare during a median follow-up of 121.5 months (range, 44.4 – 196.9). Patients who experienced renal flare had significantly higher proportion of tubulointerstitial inflammation at baseline (76.5% vs. 36.1%, p = 0.006) and tubular atrophy/interstitial fibrosis (70.6% vs. 27.8%, p = 0.003). In multivariable Cox proportional hazard regression analysis, presence of tubulointerstitial inflammation (adjusted hazard ratio (HR) 5.532, 95% confidence interval (CI) 1.722 – 17.776, p = 0.004) and tubular atrophy/interstitial fibrosis (adjusted HR 4.328, 95% CI 1.450 – 12.916, p = 0.009) at baseline were significantly associated with increased risk of renal flare. Conclusion: Presence of tubulointerstitial inflammation and tubular atrophy/interstitial fibrosis is associated with increased risk of renal flare in patients with membranous lupus nephritis. Closer monitoring of membranous lupus nephritis patients with tubulointerstitial lesions could lead to earlier treatments and better outcomes.Table. Multivariable Cox proportional hazard regression analysis evaluating risk factors of renal flare in membranous lupus nephritis Adjusted HR 95% CI P value Urine WBC ≥ 3-5/HPF 0.854 0.193 – 3.774 0.835 Lupus anticoagulant 1.118 0.039 – 4.040 0.865 Activity index (glomerular component)† 1.218 0.621 – 2.387 0.567 Chronicity index (glomerular component)* 1.135 0.752 – 1.712 0.547 Tubulointerstitial inflammation 5.532 1.722 – 17.776 0.004 Tubular atrophy/Interstitial fibrosis 4.328 1.450 – 12.916 0.009 Variables with P value less than 0.1 in the univariable analysis were selected for inclusion in the multivariable analysis. †Glomerular component of activity index, rather than total activity index, to avoid multicollinearity with tubulointerstitial inflammation *Glomerular component of chronicity index, rather than total chronicity index, to avoid multicollinearity with tubular atrophy/interstitial fibrosis Disclosure of Interests: None declared