Clinicopathological findings, treatment response and predictors of long-term outcome in a cohort of lupus nephritis patients managed according to the Euro-lupus regime: a retrospective analysis in Sri Lanka

Abstract

BackgroundDespite the improvement in survival of patients with lupus nephritis (LN) globally, there is sparse data from Sri Lanka (SL). The current study aims to describe the clinicopathological findings, treatment response and predictors of long-term outcome of patients with WHO class III–IV LN in SL, managed according to the Euro-lupus regime.ResultsOf 72 patients, 64 were females. In half of them, LN was diagnosed within the 1st year of the illness. The most common presenting feature was sub-nephrotic proteinuria. Sixteen and twenty patients had nephrotic syndrome and abnormal renal function respectively at the time of diagnosis. Fifty-four patients (75%) responded to the Euro-lupus regimen [CR, 20 (28%); PR, 34(47%)]. Later at 6 months, 65 patients (90%) achieved remission [CR, 31(43%); PR, 34 (47%)]. Seven patients experienced treatment failure. During the total duration of follow up, 54 patients remained in complete or partial remission, 26 developed renal relapses, and 19 suffered severe infective episodes. Renal relapses were more common in people who achieved partial remission than complete remission. The long term renal outcome was not associated with age, sex, severity of proteinuria, class of LN or initial renal function. Patients who achieved remission at 6 months had a good long-term outcome.ConclusionsThe demographic and clinical features of WHO class III and IV LN in Sri Lankan patients were similar to that reported in the global literature. 75% of patients responded to the Euro-lupus regimen. Therefore, this regime is a suitable initial regimen for LN patients in SL. Good long-term renal outcome can be predicted by early response to therapy. Further studies are necessary to explore better treatment options for patients who fail to achieve remission during initial therapy.

Use of EuroLupus Cyclophosphamide Dosing for the Treatment of Lupus Nephritis in Childhood-onset Systemic Lupus Erythematosus in North America

“…For a vignette about a 14-year-old girl with LN class IV, our survey found that 32% of pediatric rheumatologists would opt for EuroLupus dosing of CYC, vs only 6% of pediatric rheumatologists who were posed the same vignette in 2009. This change over time may be reflective of many factors, including more widespread adoption of EuroLupus dosing outside of Europe for the treatment of adult patients 8,10,11,15,16 as well as the encouraging follow-up outcomes from the Euro-Lupus Nephritis Trial (ELNT), which demonstrated similar renal outcomes between EuroLupus and NIH CYC dosing at 10 years. 17,18 These findings, in addition to pediatric providers acquiring positive experiences with the use of EuroLupus dosing for the treatment of LN in children and adolescents, have likely influenced practice.…”

Calcineurin Inhibitors in the Treatment of Lupus Nephritis: A Hare Versus Turtle Story?

“…The answer is maybe, because several studies suggest that an early therapeutic response in LN predicts good long-term kidney outcomes. [6][7][8] In these retrospective studies, early responses included complete remissions, partial remissions, and declines in proteinuria of at least a 50% after 3-6 months of treatment. However, these studies did not compare the long-term outcomes of 6-and 12-month complete responders, and other studies have shown that a decline in proteinuria to about 800 mg/d after 12 months of therapy also predicts good long-term kidney health.…”