Observational studyKidney international2018
A prospective observational cohort study highlights kidney biopsy findings of lupus nephritis patients in remission who flare following withdrawal of maintenance therapy.
Observational study in Kidney international, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02313974 (Lupus Flares and Histological Renal Activity at the End of the Treatment), which is not on this map. Cited by 79 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Lupus Flares and Histological Renal Activity at the End of the Treatment
Who cites it
79 citing papers in PubMed, 3 syntheses or guidelines pooled it, 169 citations in OpenAlex.
- II Brazilian Society of Rheumatology consensus for lupus nephritis diagnosis and treatment.Advances in rheumatology (London, England) · 2024Guideline
- Kidney biopsy guidebook 2020 in Japan.Clinical and experimental nephrology · 2021Guideline
- Pooled it
- Anifrolumab Treatment Leads to Rapid Reduction in Urinary Biomarkers of Intrarenal Inflammation in Lupus Nephritis: Results From the Phase 2 Randomized Trial.Arthritis & rheumatology (Hoboken, N.J.) · 2026Trial
- The Renal Activity Index for Lupus: Validation for Prediction of Kidney Inflammation in Adult Patients With Lupus Nephritis.The Journal of rheumatology · 2026Trial
- Kidney histopathology in predicting flares following drug withdrawal in proliferative lupus nephritis in clinical remission.Rheumatology international · 2024Trial
- A nomogram predicting the histologic activity of lupus nephritis from clinical parameters.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Trial
- Weaning of maintenance immunosuppressive therapy in lupus nephritis (WIN-Lupus): results of a multicentre randomised controlled trial.Annals of the rheumatic diseases · 2022Trial
- Mechanism-informed combination therapy and dynamic risk stratification in lupus nephritis: toward durable renal protection.Clinical rheumatology · 2026Review
- Kidney Biopsy and Prognosis in Lupus Nephritis: Histological Predictors of Renal Outcome-A Narrative Review.Medicina (Kaunas, Lithuania) · 2026Review
- Role of repeat kidney biopsy after 6 months of treatment in proliferative lupus nephritis.Lupus science & medicine · 2026Observational
- Factors associated with renal relapse in lupus nephritis after remission: a systematic review and meta-analysis.International urology and nephrology · 2026Review
- Repeat Kidney Biopsy in Lupus Nephritis: Diagnostic Yield and Clinical Utility in a Real-World Single-Centre Cohort.Journal of clinical medicine · 2026Article
- A Review and Future Perspective on Renal Outcome Definitions in Lupus Nephritis.ACR open rheumatology · 2026Review
- Development of a LASSO-based machine learning model for relapse prediction in lupus nephritis.Lupus science & medicine · 2026Article
- The Renal Activity Index for Lupus Identifies Active Renal Disease and Treatment Response in Adult Patients With Systemic Lupus Erythematosus and Lupus Nephritis.Arthritis care & research · 2026Article
- Evaluation of clinical, histological and biomarker response after initial therapy of lupus nephritis.Lupus science & medicine · 2026Article
- Tapering strategies for immunosuppressive, corticosteroid, and biologic therapy in lupus nephritis: a national survey of rheumatology and nephrology practices in Saudi Arabia.Rheumatology international · 2026Article
- Measurements of urinary biomarkers at 2 years following a lupus nephritis flare are associated with subsequent renal outcomes.Lupus science & medicine · 2026Article
- Tubulointerstitial inflammation driving interstitial fibrosis and tubular atrophy predicts poor renal outcome in refractory lupus nephritis.Rheumatology (Oxford, England) · 2026Article
19 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
One of the most difficult management issues in lupus nephritis (LN) is the optimal duration of maintenance immunosuppression after patients are in clinical remission. Most patients receive immunosuppression for years, based mainly on expert opinion. Prospective data are unavailable. Complicating this issue are data that patients in clinical remission can still have histologically active LN; however, the implications of this are unknown. To study this, the Lupus Flares and Histological Renal Activity at the end of Treatment study (ClinicalTrial.gov, NCT02313974) was designed to examine whether residual histologic activity predisposes to LN flares in class III and IV LN. Patients in complete clinical remission for at least 12 months who had received at least 36 months of immunosuppression were eligible. Patients consented to a second kidney biopsy, were tapered off maintenance immunosuppression and were then followed prospectively for LN flares over 24 months. Forty-four patients were enrolled, and 36 completed the study. LN flares occurred in 11 patients, and ten of these had residual histologic activity on the second biopsy. All patients with an NIH activity index over two flared. The activity index and duration of systemic lupus erythematosus at the second biopsy were independent predictors of flare. A predictive equation based on these variables discriminated between flare and no flare with a sensitivity of 100%, specificity of 88%, and a misclassification rate of 8.3%. Thus, a repeat kidney biopsy may be useful in managing maintenance immunosuppression in LN, and patients in histologic remission may be candidates for withdrawal of therapy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.