Long-Term Follow-Up of a Pure Class V Lupus Nephritis Cohort at Mayo Clinic

Background: Data on long-term outcomes in pure class V Lupus Nephritis (LN) are limited since most studies include mixed classes. Methods: Retrospective cohort study on biopsy-proven LN class V (2000-2024). Laboratory data were collected at baseline and every 6 months. We used a linear regression mixed model to estimate 5-years eGFR slopes (primary outcome). Results: Of 55 patients, 72% were female, 41% white and mean age 39.2(13.5) years. Median follow-up of 83 months. Baseline characteristics, sorted by serological status, are shown in Table 1. Compared to the anti- dsDNA+ group, anti-dsDNA− patients had higher median proteinuria and lower serum albumin. In contrast, anti-dsDNA+ cohort exhibited significantly more frequently hypocomplementemia. Interstitial fibrosis and tubular atrophy (IFTA) were more pronounced in the anti-dsDNA+ group. In anti-dsDNA negative patients, electron microscopy showed predominantly subepithelial deposits with fewer intramembranous ones. As shown in Table 2, a significant negative eGFR slope, reflecting kidney function decline, was observed at 60 months of follow-up with no difference between anti-dsDNA groups. Higher glomerular sclerosis (GS) and interstitial fibrosis (IF) are significantly associated with lower eGFR values. Mycophenolate mofetil (MMF) use was associated with improved eGFR over time. Conclusion: In our cohort, serological status was associated with clinical and histological differences. The strongest predictors of eGFR decline, regardless of serologic profile, were GS and IF. MMF improved significantly long-term renal function.