Early Renal Remission Is Associated with Increased Likelihood of Subsequent Remission in Lupus Nephritis: Single-Centre Observational Study in Australia

Reliable clinical markers for predicting sustained renal remission remain poorly understood in patients with lupus nephritis (LN). We investigated whether achieving complete renal remission (CRR) within 6 months of induction therapy, compared to within 12 months, was associated with a higher likelihood of attaining CRR at 24 months. We conducted a retrospective observational study of biopsy-proven patients with class III or IV ± V LN treated at a lupus clinic in Australia. CRR was defined as a urine protein: creatinine ratio (UPCR) of <0.05 g/mmol with no worsening of eGFR > 10% from baseline. CRR responders at 6, 12, and 24 months were determined. Associations between 6- and 12-month CRR status and 24-month CRR were examined using logistic regression. In total, 60 patients were included; 49 (82%) were female, with a median age of 27 years (IQR: 19, 39) at LN diagnosis. CRR was attained at 6, 12, and 24 months by 23 (40%), 26 (47%), and 24 (44%) of patients, respectively. Both 6- and 12-month CRR attainment were significantly associated with an increased likelihood of CRR achievement at 24 months (adjusted odds ratios 11.23 (95% CI 2.53, 49.88) and 11.39 (95% CI 2.41, 53.80), respectively). Achieving CRR at 6 and 12 months was a strong independent predictor for attaining subsequent renal remission.