scholarly journals The spectrum of C4d deposition in renal biopsies of lupus nephritis patients

2020 ◽  
Author(s):  
Ying DING ◽  
Xiaojuan YU ◽  
Lihua WU ◽  
Ying TAN ◽  
Zhen QU ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Disease Activity ◽  
Hazard Analysis ◽  
Complement Factor ◽  
Pathological Features ◽  
Peritubular Capillary ◽  
Renal Outcomes ◽  
Renal Biopsies ◽  
C4d Staining

Abstract Objectives This study aims to determine the prevalence and localization of complement factor C4d in renal biopsies of lupus nephritis (LN) patients, as well as its association with the clinico-pathological features of the disease. Especially, the correlation between arteriolar C4d deposition and renal microvascular lesions (RVL) was further analyzed. Methods A total of 325 biopsy-proven lupus nephritis patients were enrolled and their clinico-pathological data were collected. C4d staining in renal biopsies was performed by immunohistochemistry. The association between C4d deposition and the clinico-pathological features was further analyzed. Results C4d deposition was present in most of renal specimens (98.8%) in our cohort. They were localized in the glomeruli (98.2%), tubular basement membrane (TBM) (43.7%), arterioles (31.4%) and peritubular capillary (33.8%), respectively. TBM C4d staining was closely related to the disease activity (SLEDAI) and NIH pathological activity and chronicity indices (P < 0.01). Patients with arteriolar C4d deposition were more likely to develop RVL (91.2%) in comparison to those negative (78.0%; P = 0.004), especially with two or more types of RVL (P < 0.001). During an average follow-up of 55.8 months, the presence of arteriolar C4d was related to worse renal outcomes (HR: 2.074, 95% CI 1.056–4.075, P = 0.034). Co-deposition of arteriolar C4d and C3c was an independent risk factor (HR: 2.539, 95% CI 1.130–5.705, P = 0.024) for predicting renal outcomes by the multivariate stepwise Cox hazard analysis Conclusions C4d deposition was common in renal tissues of lupus nephritis patients. TBM C4d deposition was related to the disease activity and arteriolar C4d deposition was associated with RVL and worse renal outcomes.

scholarly journals The Spectrum of C4d Deposition in Renal Biopsies of Lupus Nephritis Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Ying Ding ◽  
Xiaojuan Yu ◽  
Lihua Wu ◽  
Ying Tan ◽  
Zhen Qu ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Disease Activity ◽  
Activity Index ◽  
Hazard Analysis ◽  
Disease Activity Index ◽  
Complement Factor ◽  
Pathological Features ◽  
Renal Outcomes ◽  
Renal Biopsies ◽  
C4d Staining

ObjectivesThis study aimed to determine the prevalence and localization of complement factor C4d in renal biopsies from patients with lupus nephritis (LN), as well as its associations with the disease’s clinico-pathological features. The correlation between arteriolar C4d deposition and renal microvascular lesions (RVLs) was further analyzed.MethodsA total of 325 biopsy-proven LN patients were enrolled, and their clinico-pathological data were collected. C4d staining of renal biopsies was performed by immunohistochemistry. The associations between C4d deposition and the clinico-pathological features were further analyzed.ResultsC4d deposition was present in most (98.8%) renal specimens in our cohort. These deposits were localized in the glomeruli (98.2%), tubular basement membrane (TBM) (43.7%), arterioles (31.4%), and peritubular capillary (33.8%). Patients with TBM C4d staining had higher disease activity (measured with the Systemic Lupus Erythematous Disease Activity Index) and higher National Institutes of Health pathological activity and chronicity indices (all P &lt; 0.01). Patients with arteriolar C4d deposition were more likely to develop RVLs (91.2%) compared to those with no arteriolar C4d deposition (78.0%; P = 0.004), especially with two or more types of RVLs (P &lt; 0.001). During the mean follow-up of 55.8 months, arteriolar C4d was related to worse renal outcomes [hazard ration (HR): 2.074, 95% confidence interval (CI) 1.056–4.075, P = 0.034]. Multivariate Cox hazard analysis showed that co-deposition of arteriolar C4d and C3c was an independent risk factor (HR: 3.681, 95% CI 1.519–8.921, P = 0.004) for predicting renal outcomes.ConclusionsC4d deposition was common in renal tissues from LN patients. TBM C4d deposition was related to the disease activity, and arteriolar C4d deposition was associated with RVLs and worse renal outcomes.

scholarly journals Clinical And Morphological Improvement Of Lupus Nephritis Treated With Rituximab

Folia Medica ◽  
2014 ◽  
Vol 56 (4) ◽  
pp. 245-252 ◽  
Author(s):  
Maria E. Tsanyan ◽  
Sergey K. Soloviev ◽  
Stefka G. Radenska-Lopovok ◽  
Anna V. Torgashina ◽  
Ekaterina V. Nikolaeva ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Cell Therapy ◽  
Disease Activity ◽  
B Cell ◽  
Renal Biopsy ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Renal Biopsies

Abstract Aim: TO assess the effects of rituximab (RTM) therapy on clinical and morphologic activity of lupus nephritis (LN). Material and methods: The study included 45 patients with confirmed diagnosis of systemic lupus erythematosus (SLE), unaffected by previously received standard therapy with glucocorticoids (GCs) and cytostatics. The disease activity was assessed using Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K); to assess the LN activity we used the SLICC RA/RE index. Forty-five patients with LN were given puncture renal biopsy prior to prescribing RTM; 16 patients had repeated renal biopsy 1 year and more after beginning the anti-B-cell therapy. LN was graded histologically in accordance with the WHO classification (2003) with indices of activity (AI) and chronicity (CI). Results: The predominant number of patients had class III - IV of LN. The repeated renal biopsies demonstrated that LN had undergone a transition into a more favourable morphologic class, which was associated, in most of these cases, with a positive therapeutic effect. The follow-up dynamics showed a statistically significant reduction of AI (p=0.006), and no statistically significant changes in the CI (p = 0.14). Conclusion: The long-term follow-up in the study has showed that repeated courses of anti-B-cell therapy with RTM have a positive effect both on SLE activity and generally on the renal process. The reduction of the morphologic class of LN as assessed in the repeated renal biopsies is a convincing proof for this. Eleven out of 16 patients experienced transition of the morphologic class into a more favourable type, which in most cases was combined with lower AI (p = 0.006). We found no evidence of increase in the CI (p = 0.14).

Principles of pediatric lupus nephritis in a prospective contemporary multi-center cohort

Lupus ◽  
2021 ◽  
pp. 096120332110286
Author(s):  
Kathleen M Vazzana ◽  
Ankana Daga ◽  
Beatrice Goilav ◽  
Ekemini A Ogbu ◽  
Daryl M Okamura ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Kidney Function ◽  
Lupus Erythematosus ◽  
Extensive Literature ◽  
Short Term ◽  
Renal Outcomes ◽  
Childhood Arthritis ◽  
Black Patients ◽  
End Stage

Lupus nephritis (LN) is a life-threatening manifestation of systemic lupus erythematosus (SLE) and is more common in children than adults. The epidemiology and management of childhood-onset SLE (cSLE) have changed over time, prompting the need to reassess expected outcomes. The purpose of this study is to use the Childhood Arthritis and Rheumatology Research Alliance (CARRA) prospective registry to validate historical principles of LN in a contemporary, real-world cohort. After an extensive literature review, six principles of LN in cSLE were identified. The CARRA registry was queried to evaluate these principles in determining the rate of LN in cSLE, median time from cSLE diagnosis to LN, short-term renal outcomes, and frequency of rituximab as an induction therapy. Of the 677 cSLE patients in the CARRA registry, 32% had documented LN. Decline in kidney function was more common in Black cSLE patients than non-Black patients ( p = 0.04). Black race was associated with worse short-term renal outcomes. In short-term follow up, most children with LN had unchanged or improved kidney function, and end stage kidney disease (ESKD) was rare. Ongoing follow-up of cSLE patients in the CARRA registry will be necessary to evaluate long-term outcomes to inform risk, management, and prognosis of LN in cSLE.

Urinary vitamin D-binding protein, a novel biomarker for lupus nephritis, predicts the development of proteinuric flare

Lupus ◽  
2018 ◽  
Vol 27 (10) ◽  
pp. 1600-1615 ◽  
Author(s):  
D J Go ◽  
J Y Lee ◽  
M J Kang ◽  
E Y Lee ◽  
E B Lee ◽  
...  
Keyword(s):  
Vitamin D ◽  
Lupus Nephritis ◽  
Disease Activity ◽  
Clinical Outcomes ◽  
Binding Protein ◽  
Significant Risk ◽  
Enzyme Linked Immunosorbent Assay ◽  
Vitamin D Binding Protein ◽  
Predictive Values

Lupus nephritis (LN) is a major complication of systemic lupus erythematosus (SLE). Conventional biomarkers for assessing renal disease activity are imperfect in predicting clinical outcomes associated with LN. The aim of this study is to identify urinary protein biomarkers that reliably reflect the disease activity or predict clinical outcomes. A quantitative proteomic analysis was performed to identify protein biomarker candidates that can differentiate between SLE patients with and without LN. Selected biomarker candidates were further verified by enzyme-linked immunosorbent assay using urine samples from a larger cohort of SLE patients ( n = 121) to investigate their predictive values for LN activity measure. Furthermore, the association between urinary levels of a selected panel of potential biomarkers and prognosis of LN was assessed with a four-year follow-up study of renal outcomes. Urinary vitamin D-binding protein (VDBP), transthyretin (TTR), retinol binding protein 4 (RBP4), and prostaglandin D synthase (PTGDS) were significantly elevated in SLE patients with LN, especially in patients with active LN ( n = 21). Among them, VDBP well correlated with severity of proteinuria (rho = 0.661, p < 0.001) and renal SLE Disease Activity Index (renal SLEDAI) (rho = 0.520, p < 0.001). In the four-year follow-up, VDBP was a significant risk factor (hazard ratio 9.627, 95% confidence interval 1.698 to 54.571, p = 0.011) for the development of proteinuric flare in SLE patients without proteinuria ( n = 100) after adjustments for multiple confounders. Urinary VDBP correlated with proteinuria and renal SLEDAI, and predicted the development of proteinuria.

A Validation of the 2018 Revision of International Society of Nephrology/Renal Pathology Society Classification for Lupus Nephritis: A Cohort Study from China

2020 ◽  
Vol 51 (6) ◽  
pp. 483-492 ◽  
Author(s):  
Juan Tao ◽  
Hui Wang ◽  
Xiao-Juan Yu ◽  
Ying Tan ◽  
Feng Yu ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
International Society ◽  
Interstitial Fibrosis ◽  
Activity Index ◽  
Renal Pathology ◽  
Tubular Atrophy ◽  
Female Ratio ◽  
Renal Outcomes

Background: A revision of the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification for lupus nephritis has been published in 2018. The current study aimed to verify the utility of this system. Materials and Methods: A total of 101 lupus nephritis patients from a large Chinese cohort who underwent renal biopsy in Peking University First Hospital were reevaluated by 2 renal pathologists, who had no knowledge of the clinical findings. The association between clinical data at the time of initial renal biopsy and follow-up and pathological features were further analyzed on all patients selected. Results: The mean age of the cohort was 33 years with a male/female ratio of 1:9, and a median follow-up period of 128 months. The presence and extent of mesangial hypercellularity, endocapillary hypercellularity, global and segmental glomerulosclerosis, neutrophil exudation/karyorrhexis, glomerular hyaline deposits, extracapillary proliferation (crescents), tubular atrophy/interstitial fibrosis, and interstitial inflammation were significantly correlated with several clinical renal injury indices (systemic lupus erythematosus disease activity index, serum creatinine value, proteinuria, and C3 level) at the time of biopsy. By multivariable Cox hazard analysis, fibrous crescents, tubular atrophy/interstitial fibrosis, and the modified National Institutes of Health chronicity index were independent risk factors for patients’ composite renal outcomes (hazard ratio [HR] 4.100 [95% CI 1.544–10.890], p = 0.005; HR 8.584 [95% CI 2.509–29.367], p = 0.001; and HR 3.218 [95% CI 1.138–9.099], p = 0.028; respectively). Conclusions: The 2018 revision of the ISN/RPS classification for lupus nephritis has utility for prediction of clinical renal outcomes.

scholarly journals Comparison of the Clinical Implications among Five Different Nutritional Indices in Patients with Lupus Nephritis

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1456 ◽  
Author(s):  
Sung Ahn ◽  
Juyoung Yoo ◽  
Seung Jung ◽  
Jason Song ◽  
Yong-Beom Park ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Disease Activity ◽  
Hazard Analysis ◽  
Risk Index ◽  
Laboratory Data ◽  
Proportional Hazard ◽  
Nutritional Indices ◽  
Cox Proportional Hazard ◽  
Nutritional Risk Index ◽  
Conut Score

Systemic lupus erythematosus (SLE) is characterized with aberrant responses in the immune systems and lupus nephritis (LN) is one of the most serious complications of SLE. This study evaluated the clinical significance of different nutritional indices in 207 renal biopsy-proven LN patients. The clinical and laboratory data were reviewed, and five different nutritional indices were calculated: (i) Controlling nutritional status (CONUT) score; (ii) prognostic nutritional index (PNI); (iii) nutritional risk index; (iv) neutrophil-to-lymphocyte ratio; and (v) body mass index. The factors associated with end-stage renal failure (ESRF) were assessed using a Cox-proportional hazard analysis. The patients with ESRF had significantly lower median PNI (31.1 vs. 34.7, p = 0.012) than those without ESRF at baseline. The CONUT score and PNI had the highest correlation between the SLE disease activity index-2000 (r = 0.467 and p = −0.356, all p < 0.001) and was significantly associated with SLE activity-related measures. In the Cox-proportional hazard analysis, PNI (odds ratio 0.925, 95% confidence interval 0.865–0.989, p = 0.022) was independently associated with ESRF along with creatinine and chronicity index, and the renal survival rate was significantly lower in patients with PNI ≤35.41 than in those with PNI >35.41 (p = 0.003). Among nutritional indices, the CONUT score and PNI better correlated with disease activity and PNI was associated with ESRF.

scholarly journals Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study

2019 ◽  
Vol 32 (10) ◽  
pp. 635 ◽  
Author(s):  
David Navarro ◽  
Ana Carina Ferreira ◽  
Helena Viana ◽  
Fernanda Carvalho ◽  
Fernando Nolasco
Keyword(s):  
Renal Function ◽  
Lupus Nephritis ◽  
Renal Biopsy ◽  
International Society ◽  
Activity Index ◽  
Renal Pathology ◽  
Response To Treatment ◽  
Clinical Activity ◽  
Renal Outcomes

Introduction: Lupus nephritis is a serious complication of systemic lupus erythematosus. Currently, therapy is guided by findings in the renal biopsy, following the International Society of Nephrology / Renal Pathology Society classification. Austin and Hill’s histomorphological indexes are not routinely obtained. In this retrospective single-centre study, we aimed to analyze the importance and applicability of the different morphological indexes in predicting response to treatment and prognosis.Material and Methods: Patients with kidney biopsy demonstrating lupus nephritis from the 2010 – 2016 period were included. We analyzed their demographic data, comorbidities, clinical presentation and laboratorial evaluation at the time of renal biopsy. We evaluated the following outcomes: clinical remission, renal function and proteinuria at end of follow-up. Histologic analysis was performed using the International Society of Nephrology / Renal Pathology Society classification and the morphological indexes described by Austin (Activity and Chronicity) and Hill. Univariate and multivariate statistical analysis was performed using STATA software.Results: We analyzed 46 biopsy-proven lupus nephritis cases, with a median follow-up of 31.9 (13.2 – 45.6) months. Based on biopsy findings, 35 patients were started on immunosuppressive therapy. We observed that Class IV patients had, at presentation, lower estimated glomerular filtration rate (67.3 vs 94.6 mL/min; p = 0.02), higher proteinuria (4.26 vs 2.37 g/24 hours; p = 0.02) and a non-significantly higher C3 consumption (58.9 vs 77.4 mg/dL; p = 0.06). We did not observe correlations between International Society of Nephrology / Renal Pathology Society classification and the outcomes at the end of follow-up. In contrast, both the Hill biopsy index and Austin’s Chronicity index were correlated with renal function and proteinuria at the end of follow-up. Austin’s Activity index correlated with the immunological findings (C3, C4 and anti-dsDNA) at presentation.Discussion: Because clinical activity poorly correlates with histologic activity, histological findings are fundamental when assessing patients with suspected lupus nephritis. The most recent International Society of Nephrology / Renal Pathology Society report supports the European League Against Rheumatism guidelines, encouraging the adoption of histomorphological indexes when evaluating lupus nephritis. Our data, showing a correlation between the renal outcomes and the indexes described by Austin and Hill, supports this view.Conclusion: The histomorphological indexes in lupus nephritis are easily obtainable, can predict renal outcomes and may help in the management of such patients.

scholarly journals AB0398 TNF-LIKE WEAK INDUCER OF APOPTOSIS / FGF INDUCIBLE MOLECULE 14 PATHWAY IN UNTREATED LUPUS NEPHRITIS: SERUM OR URINE TWEAK LEVELS MORE ACCURATE IN RELATION TO RENAL ACTIVITY?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1498.1-1499
Author(s):  
M. Bekhit ◽  
N. Abaza ◽  
N. Kamel ◽  
M. Ossman ◽  
S. Saad El Din
Keyword(s):  
Lupus Nephritis ◽  
Disease Activity ◽  
Significant Positive Correlation ◽  
Activity Index ◽  
Disease Activity Index ◽  
Newly Diagnosed ◽  
Tubular Cells ◽  
Renal Tubular Cells ◽  
Renal Biopsies ◽  
Renal Tubular

Background:Lupus nephritis (LN) is one of the most serious manifestations of SLE, affecting 70% of patients and the most critical predictor of morbidity and mortality of the disease [1].Tumor necrosis factor-like weak inducer of apoptosis/ fibroblast growth factor inducible molecule 14 (TWEAK/Fn14) activation is involved in various pathological processes that occur locally in kidneys, facilitating the pathogenesis of LN [2].Objectives:To assess serum and urine TWEAK levels as well as renal Fn14 expression in newly diagnosed patients with LN and its correlation to disease activity.Methods:The present study included 30 selected newly diagnosed previously untreated SLE patients divided into 2 groups; 15 patients with LN and 15 without LN as well as 30 age and sex matched healthy subjects who served as control group. Written consent was obtained from all patients and controls after a full explanation of the study. Clinical assessment of disease activity by SLE Disease activity index (SLEDAI) [3]. Lupus nephritis was assessed clinically with the renal SLE disease activity index (rSLEDAI).Indicated renal biopsies were taken from the patients with LN and were classified according to the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) classification [4].Serum and urinary levels of TWEAK were measured for the patients and controls using enzyme-linked immunosorbent assay (ELISA). Fn 14 was examined in renal biopsies from LN group by immunohistochemistry.Results:A significantly higher uTWEAK level on comparing SLE patients with LN to those without LN and controls (F = 149.2,P< 0.001). uTWEAK had a highly significant positive correlation with, proteinuria (r = 0.755,P< 0.001), a significant positive correlation with SLEDAI and rSLEADI (r = 0.217,P< 0.037) (r = 0.476,P< 0.024) respectively. uTWEAK had a significant negative correlation with anti-dsDNA titres, C3 and C4 (r = -0.579,P< 0.008) (r = -0.456,P< 0.011) (r = -0.552,P< 0.002). Although sTWEAK level was higher in SLE patients than controls, it was not found to be associated with the presence of LN (F = 4.963, P =0.012). Fn14 expression was detected in glomerular and tubular cells in LN patients.Expression of Fn14 in renal biopsies from LN patients was examined.Immunohistochemistry for Fn14 was detected in(A) glomerular endothelial cells,(B, C) some specimens showed moderate and intense staining for Fn14 in renal tubular cells. In the controls [renal biopsies from patients with renal cell carcinoma(D)], there was very slight staining for Fn14 in renal tubular cells.Conclusion:Urinary TWEAK is a specific and sensitive biomarker for detection of active LN in newly diagnosed untreated SLE patients.References:[1]Kwok SK and Tsokos GC. New insights into the role of renal resident cells in the pathogenesis of lupus nephritis. Korean J Intern Med 2018; 33 (2): 284-289.[2]Xia Y, Herlitz LC, Gindea S, Wen J, Pawar RD, Misharin A, et al. Deficiency of Fibroblast Growth Factor-Inducible 14 (Fn14) Preserves the Filtration Barrier and Ameliorates Lupus Nephritis. J Am Soc Nephrol 2015; 26(5):1053-1070.[3]Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH, Derivation of the SLEDAI. A disease activity index of lupus patients. Arthritis Rheum 1992; 35: 630-40.[4]Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 2004; 15(2): 241-250.Disclosure of Interests:None declared

scholarly journals POS0694 REAL-WORLD ECONOMIC IMPLICATIONS OF ACHIEVING LOW DISEASE ACTIVITY IN LUPUS NEPHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 595.1-595
Author(s):  
M. Dall’era ◽  
T. Hermes ◽  
M. Eaddy ◽  
A. Ogbonnaya ◽  
E. Farrelly ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Medical Costs ◽  
Systemic Lupus ◽  
Economic Implications ◽  
Low Disease Activity ◽  
Active Disease

Background:Lupus nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus (SLE) affecting 50% of SLE patients and leading to end-stage kidney disease (ESKD) in up to 30% of patients with LN.1 Previous studies have reported higher healthcare costs in patients with SLE that develop LN compared to patients without LN.2-5 These studies captured overall treatment costs associated with LN, regardless of disease activity or severity, and were conducted in small patient populations.Objectives:The aim of this study was to assess the real-world economic implications of achieving low disease activity compared to active disease or ESKD in a large LN population.Methods:This study was a retrospective observational analysis of patients with LN within Optum’s health plan identified with ICD9 or ICD10 codes to have LN between January 1, 2015, and December 31, 2019. Patients were ≥18 years of age and had ≥2 months of follow-up data available. Patients were followed until death, loss to follow-up, or December 31, 2019. Low disease activity was defined by evidence of glucocorticoid doses ≤5 mg/day, evidence of mycophenolate mofetil (MMF) doses ≤2 g/day, and no use of cyclophosphamide for ≥6 consecutive months. Follow-up time that could not be defined as low disease activity was defined as active disease periods, except for periods with evidence of ESKD. Healthcare payer costs for medical and pharmacy services were compared between periods of low disease activity, active disease, and ESKD. A univariate generalized estimating equation model accounting for interdependence was used to compare differences in costs between periods of active and low disease activity.Results:A total of 21,251 patients with LN met study criteria with a mean follow-up time of 31.0 months. The mean age was 60.3 years; 86.9% of patients were female and 35.2% of patients were non-White race. Low disease activity was evident in 51.3% of patients with a mean duration of 27.5 months. Mean monthly medical costs were $2,523 during periods of low disease activity and $4,777 during periods of active disease. After factoring in pharmacy costs, mean monthly total costs were $3,584 during periods of low activity and $6,612 during periods of active disease (P<0.001). The mean monthly costs of ESRD were $18,084 for medical and $3,760 for pharmacy.Conclusion:Achieving low disease activity in patients with LN is associated with reduced economic burden to healthcare payers, with monthly medical costs averaging $2,254 less and total monthly costs averaging $3,028 less than costs during periods of active disease.References:[1]Parikh SV et al. Update on Lupus Nephritis: Core Curriculum 2020. Am J Kidney Dis. 2020;76(2):265-281.[2]Bartels-Peculis L et al. Treatment patterns and health care costs of lupus nephritis in a United States payer population. Open Access Rheumatol. 2020;12:117-124.[3]Furst DE et al. Medical costs and healthcare resource use in patients with lupus nephritis and neuropsychiatric lupus in an insured population. J Med Econ. 2013;16(4):500-509.[4]Li T et al. Long-term medical costs and resource utilization in systemic lupus erythematosus and lupus nephritis: a five-year analysis of a large Medicaid population. Arthritis Rheum. 2009;61(6):755-763.[5]Pelletier EM et al. Economic outcomes in patients diagnosed with systemic lupus erythematosus with versus without nephritis: results from an analysis of data from a US claims database. Clin Ther. 2009;31(11):2653-2664.Disclosure of Interests:Maria Dall’Era Speakers bureau: Consulting agreement with Aurinia for Advisory Boards and educational lectures, Tim Hermes Shareholder of: Aurinia Pharmaceuticals Inc., Employee of: Aurinia Pharmaceuticals Inc., Michael Eaddy Consultant of: Aurinia Pharmaceuticals Inc., Augustina Ogbonnaya Consultant of: Aurinia Pharmaceuticals Inc., Eileen Farrelly Consultant of: Aurinia Pharmaceuticals Inc., Paola Mina-Osorio Shareholder of: Aurinia Pharmaceuticals Inc., Employee of: Aurinia Pharmaceuticals Inc.

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