Treatment outcome in different classes of Lupus nephritis

Abstract

Objective: To evaluate treatment outcomes across different classes of lupus nephritis and to assess the association of baseline serum creatinine and proteinuria with remission status.

Methodology: This prospective observational study included 157 adult patients with biopsy-proven lupus nephritis at a tertiary care center. Patients were classified according to the ISN/RPS classification and treated according to standard protocols based on LN class. Baseline demographics, clinical features, serum creatinine, proteinuria, complement levels, and anti-dsDNA antibodies were recorded. Outcomes were categorized as complete remission, partial remission, no response, or progression to end-stage renal disease (ESRD). Statistical analyses were performed using SPSS, with a significance level of p ? 0.05.

Results: The cohort included predominantly female patients (84.1%), with a mean age of 33.8 ± 9.6 years. Class IV LN was the most frequent (38.9%), followed by Class III (24.8%) and Class V (14.0%). Complete remission was achieved in 38.2% of patients, partial remission in 38.9%, no response in 13.4%, and 9.6% progressed to ESRD. Patients achieving complete remission had significantly lower baseline serum creatinine (1.32 ± 0.48 vs 2.11 ± 0.74 mg/dL; p < 0.001) and proteinuria (2.41 ± 0.86 vs 4.12 ± 1.23 g/day; p < 0.001) compared with those with partial remission. Treatment outcomes differed significantly among LN classes (p < 0.001), with Class I and II showing the highest rates of complete remission and Class VI the poorest response.

Conclusion: Histological class, baseline renal function, and proteinuria are key determinants of treatment outcomes in lupus nephritis. Patients with lower serum creatinine and proteinuria at presentation are more likely to achieve complete remission, highlighting the importance of early detection and aggressive management to improve renal prognosis.