Factors associated with renal response in patients with lupus nephritis: a single‑center retrospective cohort study

Abstract

Objective: to characterize the clinical, laboratory, and histopathological features of patients with lupus nephritis (LN) and identify factors associated with renal response after 12 months of treatment. Materials and methods : This single-center retrospective cohort study included adult patients with systemic lupus erythematosus (SLE) and biopsy-proven LN. Renal response was assessed according to the KDIGO 2024 guidelines. Ordinal logistic regression was used to identify factors associated with the level of renal response (no response, partial response, complete response) at 12 months. Results: A total of 54 patients with biopsy-proven LN and sufficient follow-up after kidney biopsy were included in the 12-month renal response analysis. Most patients were women (85%). The median age at the onset of kidney involvement was 29 [22-39] years. Proliferative LN (classes III to IV-V) was identified in 72% of patients. Median baseline proteinuria was 3.4 (1.6-4.0) g/day. A complete renal response was achieved in 38% of patients at 6 months and in 48% at 12 months. At 12 months, an additional 30% of patients had achieved a partial renal response, whereas 22% had no response. Mycophenolate mofetil–based regimens were associated with greater odds of achieving a better renal response (OR 3.08; 95% CI 1.10-8.96; p=0.03). Hydroxychloroquine use was also associated with a greater likelihood of renal response (OR 3.60; 95% CI 1.08-12.70; p=0.04). In the multivariable model, combined class III+V LN was independently associated with a better of renal response (OR 16.69; 95% CI 2.17-381.19; p=0.02), whereas a low baseline eGFR (<30 mL/min/1.73 m 2 ) was associated with a lower likelihood of response (OR 0.09; 95% CI 0.01-0.42; p<0.01) Conclusions: Baseline kidney function and the histopathological class of LN are key factors associated with treatment response.