Clinical outcomes and prognostic factors in lupus nephritis: impact of remission on renal and overall survival in a single-center study

Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus. This study aimed to evaluate clinical outcomes in patients with LN, including progression to chronic kidney disease (CKD), end-stage kidney disease (ESKD), and mortality. This retrospective study included all patients diagnosed with LN via kidney biopsy between January 2010 and March 2022. Rates of cumulative renal survival and overall survival, as well as cumulative survival based on the development of ESKD, were compared according to treatment response. A total of 125 patients with LN were included in the analysis, with a mean follow-up period of 59.9 ± 32.4 months. Overall, 58 patients (46.4%) achieved complete remission, 35 (28%) partial remission, and 32 (25.6%) did not respond to treatment. Baseline clinical characteristics were similar across groups. Patients in complete remission experienced significantly higher rates of cumulative renal and overall survival compared to those with partial or no treatment response (log-rank: P <0.001). Progression to ESKD occurred in 20 patients (16.0%), and 18 (14.4%) died. After multivariable adjustment, low C3 at diagnosis was independently associated with higher odds of treatment non-response (adjusted OR 5.29, 95% CI 1.52–21.3). Achieving complete remission was strongly protective against renal events (doubling of creatinine) (adjusted HR 0.11, 95% CI 0.03–0.39, p < 0.001). Additionally, non-responders were at higher risk of CKD, ESKD, and mortality, with P values of <0.001, 0.005, and 0.014, respectively. The findings of this study emphasize the importance of early detection, prompt treatment, and vigilant monitoring to optimize patient outcomes. Achieving complete remission is critical for improved renal and overall survival in patients with LN. In particular, low C3 levels at diagnosis was associated with poor treatment response. Future multicenter prospective research is needed to validate these findings. • Achieving complete remission in lupus nephritis is crucial, as non-responders face significantly higher risks of CKD, ESKD, and mortality. • After adjustment for confounders, low serum C3 at diagnosis was independently associated with a higher likelihood of treatment non-response. • Patients who developed lupus nephritis more than two years after SLE diagnosis showed similar renal and overall survival compared with those who developed it earlier after multivariable adjustment. • Future prospective research is needed to validate these findings.