{
  "abstract": "Objectives To study a series of refractory LN including therapy and the long-term evolution.Methods Multicenter longitudinal cohort study including refractory LN. LN was defined according to GLOSEN consensus as failure to reduce proteinuria at least >25% or worsening of proteinuria and/or renal function after at least 3 months of triple immunosuppressive (IS) therapy (1). Demographic, clinical and analytical data and treatments were collected.Results We included 68 patients (61 women/7 men), mean ageSD of 39.1±36 years (range 19–81 years). The diagnosis was confirmed by renal biopsy in all patients and the LN subtypes were: LN class I (n= 1; 1.5%), class II (n= 3; 4.4%), class III (n= 11; 16.2%), class IV (n= 31; 45.6%), class V (n= 10; 47.7%), class IV+V (n= 7; 10.3%), class III+V (n= 3; 4.4%), class II+V (n= 1; 1.5%) and class III+V (n= 1; 1.5%). The main extrarenal and renal manifestations are shown in the table 1.The treatments previously received were (n): steroids (67), cyclophosphamide (CYM) (25), rituximab (RTX) (9), mycophenolate mofetil (MMF) (56), azathioprine (AZA) (11), antimalarials (62), tacrolimus (8) and belimumab (BLM) (12).After a mean±SD duration of treatment until non-response of 16.1±9.5 months, worsening of renal failure (25%), persistent proteinuria (61.76%) and persistent proteinuria and renal failure (13.24%).The evolution of creatinine, proteinuria in 24-hour urine, C3 and C4 levels are shown in the figure 1.The treatment received after non-response was: steroids (n= 50), CYM (16), RTX (n= 19), MMF (n= 41), AZA (n= 11), antimalarials (n= 55), tacrolimus (n= 27), everolimus (1), belimumab (BLM) (19) and anifrolumab (1). After a follow-up of 59.7±46 months, 41 patients (60.3%) achieved remission. However, 6 patients need hemodialysis and 4 a kidney transplant.The main complications of these 68 patients were: infections (n= 21), cervical intraepithelial neoplasia (n=1) avascular necrosis of the hip (n= 2), pulmonary thromboembolism (n= 1), comminuted ankle and radial head fracture (n= 1) and oligomenorrhea (n= 1).Conclusions More than half of patients achieve remission after modifying or intensifying initial immunosuppressive therapy.",
  "authors": [
    {
      "affiliations": [
        "Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Spain"
      ],
      "name": "Vanesa Calvo Del Río"
    },
    {
      "affiliations": [
        "Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Spain"
      ],
      "name": "Carmen Secada- Gómez"
    },
    {
      "affiliations": [
        "Hospital Universitario 12 de Octubre, Madrid, Spain"
      ],
      "name": "Celia González-García"
    },
    {
      "affiliations": [
        "Hospital Universitario 12 de Octubre, Madrid, Spain"
      ],
      "name": "Paúl Hernández Velasco"
    },
    {
      "affiliations": [
        "Hospital Universitario 12 de Octubre, Madrid, Spain"
      ],
      "name": "Enrique Morales Ruiz"
    },
    {
      "affiliations": [
        "Germans Trias i Pujol, Barcelona, Spain"
      ],
      "name": "Raquel Ugena-García"
    },
    {
      "affiliations": [
        "Germans Trias i Pujol, Barcelona, Spain"
      ],
      "name": "Anne Margaret Riveros Frutos"
    },
    {
      "affiliations": [
        "Hospital Universitario Donostia, San Sebastián, Spain"
      ],
      "name": "Joaquín Belzunegui Otano"
    },
    {
      "affiliations": [
        "Hospital de Cabueñes, Gijón, Spain"
      ],
      "name": "Anahy María Brandy García"
    },
    {
      "affiliations": [
        "Hospital Universitario de Torrevieja, Alicante, Spain"
      ],
      "name": "Ángel García Manzanares"
    },
    {
      "affiliations": [
        "Hospital Universitario del Henares, Coslada, Spain"
      ],
      "name": "Jose Ramón Lamua Riazuelo"
    },
    {
      "affiliations": [
        "Hospital Universitario Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Sebastian Sandoval"
    },
    {
      "affiliations": [
        "Hospital Universitario Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Josefina Cortés Hernández"
    },
    {
      "affiliations": [
        "Hospital Galdakao, Bilbao, Spain"
      ],
      "name": "Irati Urionagüena Onaindia"
    },
    {
      "affiliations": [
        "Hospital Clínico Universitario de Salamanca, Salamanca, Spain"
      ],
      "name": "Susana Gómez Castro"
    },
    {
      "affiliations": [
        "Hospital Provincial de Pontevedra, Pontevedra, Spain"
      ],
      "name": "Sabela Fernández Aguado"
    },
    {
      "affiliations": [
        "Complejo Asistencial de Ávila, Ávila, Spain"
      ],
      "name": "Montserrat Corteguera Coro"
    },
    {
      "affiliations": [
        "Hospital General Río Carrión, Palencia, Spain"
      ],
      "name": "Aaron Josue Fariña Gonzalez"
    },
    {
      "affiliations": [
        "Hospital General de Segovia, Segovia, Spain"
      ],
      "name": "María Álvarez Del Buergo"
    },
    {
      "affiliations": [
        "Hospital Universitario de Burgos, Burgos, Spain"
      ],
      "name": "Andrés Lorenzo Martín"
    },
    {
      "affiliations": [
        "Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Spain"
      ],
      "name": "Luis Martín Penagos"
    },
    {
      "affiliations": [
        "Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Spain"
      ],
      "name": "Ricardo Blanco"
    }
  ],
  "title": "PO:09:246 Refractory lupus nephritis: Spanish multicenter study",
  "uid": "c6c06982-aa15-5f9d-b527-8cb8caf8c806"
}