Ab1105 Prevalence, Characteristics and Outcomes of Lupus Nephritis in Morocco: A Case Series of 511 Patients

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Background: Lupus Nephritis (LN) constitutes one of the most serious visceral manifestations of systemic lupus erythematosus (SLE) that can be life-threatening and functionally crippling. Looking for signs suggestive of glomerulonephritis should be part of the initial workup, but also of the regular follow-up of any lupus patient, since suspicion of glomerulonephritis requires a renal biopsy and may condition immunosuppressive treatment. Objectives: The objective of this work is to analyze the clinical-biological, histological and progressive characteristics as well as the predictive factors of LN. Methods: This is a retrospective analytic study from a cohort of 511 cases of SLE, conducted in the Internal Medicine Department of the Ibn Sina University Hospital in Rabat, during a period from 2010 to 2023. Inclusion criteria were patients over 16 years of age with a positive diagnosis of SLE according to ACR/EULAR 2019 criteria associated with documented renal involvement. Results: During the study period, 196 cases of Lupus Nephritis were recorded. A clear predominance of females was noted, with 90.3% of cases. Lupus nephropathy was inaugural in 44.8% of cases. At the time of initial presentation, arterial hypertension was present in 28% of cases, hematuria in 52.5%, proteinuria in 98.4% and renal failure in 25%. On renal biopsy, class II was found in 3.06% of patients, class III in 29.08%, class IV in 46.93%, class V in 15.3% and 5.71% of composite forms. The main factors significantly associated with renal involvement were: skin involvement in 94.5% of cases, joint involvement in 86.9% of cases, associated hematological involvement in 85.8%, low complement in 96.7% of cases, presence of antinuclear antibodies in all patients and anti-DNA antibodies in 97.8%, and finally, inflammatory syndrome was found in 88% of cases. All patients received initial corticosteroid therapy, 56.62% of them in the form of intravenous boluses, followed by oral corticosteroids, 90.8% with Hydroxychloroquine, 73.9% with cyclophosphamide, 23.9% with Mycophenolate Mofetil, and 15.2% with Rituximab. Azathioprine was the most widely used maintenance treatment, taken by 92.3% of patients. Complete renal remission was achieved in 69.8% of cases. Renal relapse was observed in 19.3% of patients. Among complications arising during the course of the disease, 56.7% presented infectious complications, and 4.3% progressed to end-stage renal failure. Death occurred in 7.6% of cases. The presence of initial hypertension, nephrotic syndrome, initial renal failure and depth of lymphopenia were significantly correlated with an increased risk of relapse and progression to chronic renal failure. Conclusion: Despite better understanding of disease pathogenesis and improved treatment options, LN remains a major cause of morbidity and death in patients with SLE. Thus, early and accurate diagnosis of LN and prompt initiation of treatment are of paramount importance in improving outcomes in patients with SLE. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.