The risk of chronic kidney disease (CKD) is higher in patients with lupus nephritis who never achieve remission or who experience flares, investigators reported at the 60th European Renal Association Congress in Milan, Italy.

Among 303 patients with lupus nephritis, CKD developed in 57 (18.8%) during a mean 14 years. CKD developed in 56% of 46 patients who never achieved remission and 21.8% of 142 patients who experienced flares, Giulia Frontini, MD, of San Paolo Hospital in Milan, Italy, and colleagues reported. None of the 115 patients who maintained remission progressed to CKD.

The investigators tallied 174 systemic lupus erythematosus (SLE) flares over 17.8 years. Of these, 20 were nephritic flares (defined as serum creatinine increases), 112 were proteinuric flares, and 42 were extra-renal SLE flares. CKD developed in a significantly higher proportion of patients with nephritic flares (55%) than proteinuric flares (16.9%) or extra-renal flares (2.4%), the investigators reported.

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Longer remission periods were associated with lower flare risk but never eliminated it. Lupus nephritis remission lasting at least 3 years protects against CKD development, the investigators concluded. The freedom from CKD rate at 10 years was 93% in patients with at least 3 years of remission, compared with 67% in patients with less than 3 years of remission.

Hydroxychloroquine therapy was significantly associated with 38% increased odds of remission, the investigators reported. Absence of arterial hypertension and age older than 40 years were significantly associated with 30% and 1.7% increased odds of remission, respectively.

“Achievement of remission and prevention of flares are important therapy targets in patients with lupus nephritis in order to avoid the development of systemic and kidney chronic damage,” according to Dr Frontini’s team.


Frontini G, Quaglini S, Gatto M, et al. Risk of CKD in lupus nephritis: correlation with duration of remission and development of renal and extrarenal flares. Presented at: ERA 2023 Congress; 2023 June 15-18; Milan, Italy. Abstract 3191.