Lupus Nephritis Outcomes: Clinical, Treatment, and Socioeconomic Insights from India

Background: Lupus nephritis affects around 60% of SLE patients and is a major cause of morbidity and mortality. The disease exhibits variability in presentation, treatment response, and outcomes across different populations. Despite its clinical significance, the influence of socioeconomic factors on LN-related infections and overall prognosis remains inadequately studied. Methods: This ambispective study analyzed 242 biopsy-confirmed LN patients from 2018 to 2023. Clinical, biochemical, and histopathological data were assessed alongside demographic and socioeconomic parameters using the Modified Kuppuswamy Scale (2018). Key predictors of remission, infections, end-stage renal disease (ESRD), and mortality were identified. Results: The cohort had a mean age of 29.57±9.47 years, with 87.2% being female. Class IV LN was the most prevalent histological subtype (40.9%), followed by Class V (23.6%). Complete remission was achieved in 50.2%, partial remission in 20.3%, while 29.4% showed no remission. Complete remission was associated with lower activity and chronicity indices, higher C3, and lower proteinuria at induction.(Fig 1) Poor response predictors included antiphospholipid syndrome (p=0.008), hypertension (p=0.016), high SLEDAI scores, low complement, elevated activity/chronicity indices (p<0.001). Infections occurred in 26.4% of patients, with tuberculosis being the most frequent (12.8%). ESRD and mortality rates were 9.5% and 4.7%, respectively. Although most patients belonged to the upper-lower socioeconomic group (71.1%), socioeconomic status did not significantly affect remission rates (p=0.226) or mortality (p=0.409). Conclusion: Hypertension, antiphospholipid syndrome, disease activity, and histopathology were key factors influencing LN outcomes. Immunosuppressive therapy achieved good remission despite high infection rates. Socioeconomic status did not significantly affect outcomes, highlighting the importance of personalized management combining clinical and socioeconomic factors for LN patients.Remission Status and Key Clinical Parameters