Typical response to treatment in SLE

What is the typical response to treatment in SLE?

There are many variables predictive of outcome, but with severe lupus nephritis and normal kidney function, 60% to 85% of patients will achieve a complete or partial remission in 3 to 6 months with induction therapy.

This response rate is less likely with abnormal kidney function.

Because kidney function correlates directly with response to therapy, early diagnosis of lupus nephritis with a kidney biopsy is imperative.

Overall, about 10% of patients with lupus nephritis will progress to end-stage kidney disease. Clinical factors associated with progression of kidney failure are:

• Failure to achieve an initial remission

• Nephrotic-range proteinuria

• Hypertension

• Anemia

• Anti-Ro/SSA antibodies

• African American or Hispanic ethnicity

• Crescents on the biopsy

• Severe lupus lesions with or without membranous nephritis

• Extensive tubulointerstitial disease 

Factors Predictive of Progression to Kidney Failure in Lupus Nephritis

Clinical factors at baseline:

• Elevated serum creatinine
• Hypertension
• Nephrotic-range proteinuria
• Anemia
• Race: African American or Hispanic
• Anti-Ro/SSA antibodies

Clinical factors on follow-up:

• Delay in treatment
• Frequency and severity of relapse
• Failure to achieve complete or partial remission
• Increasing serum creatinine

Histopathologic:

• Severe lupus nephritis lesions
  • Membranous lesions with either focal or diffuse proliferative lesions have higher risk than isolated membranous lesions
• Presence of crescents
• Tubulointerstitial disease
• High chronicity index
• Thrombotic microangiopathy