Targeting Low Disease Activity in Lupus Nephritis Improves Long-Term Kidney Outcomes

Achieving lupus low disease activity state (LLDAS) in patients with lupus nephritis (LN) significantly reduces the risk of renal relapse and supports long-term kidney function preservation, according to a newly published study in Arthritis & Rheumatology.

This multicenter, retrospective analysis included 245 patients with LN treated at Queen Mary Hospital and Pamela Youde Nethersole Eastern Hospital in Hong Kong between 2010 and 2020. At 12 months, 49% of patients in the discovery cohort achieved LLDAS, compared with 40% achieving complete renal response (CRR). Only 10% achieved remission according to Definition of Remission In SLE criteria. 

The study demonstrated that concurrent attainment of both CRR/partial renal response (PRR) and LLDAS correlated with superior relapse-free survival (p<0.001). In multivariate analysis, both CRR/PRR (HR=0.31; p=0.007) and LLDAS (HR=0.38; p=0.029) independently predicted reduced relapse risk.

“LLDAS is an attainable target in LN comparable to CRR/PRR,” the authors noted. “Attainment of both targets is associated with additional benefit on relapse risk reduction.” They further emphasized that early achievement of LLDAS “is associated with renal function preservation,” reinforcing its clinical importance beyond conventional renal endpoints.

Reference:

Cheung CK, Yap DYH, Lee KL, et al. Treating lupus nephritis patients to lupus low disease activity reduces renal relapse and preserves long-term kidney function. Arthritis Rheumatol. Published online July 20, 2025. doi:10.1002/acr.25611