{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T17:50:21Z","timestamp":1774374621203,"version":"3.50.1"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T00:00:00Z","timestamp":1712793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deputyship for Research &amp; Innovation, Ministry of Education in Saudi Arabia","award":["RI-44-0017"],"award-info":[{"award-number":["RI-44-0017"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Immunosuppression (IS) is a standard therapy for lupus nephritis (LN). Data on the outcomes of patients with LN after the discontinuation of immunosuppression remain uncertain. This study aimed to evaluate the outcomes and results of patients with lupus nephritis (LN) who ceased immunosuppressive (IS) therapy. Methods: Records were obtained on the clinical and laboratory features of LN patients who were treated at our Lupus Unit. They included median values and ranges for various numerical variables such as patient age, disease duration, and treatment duration. Categorical variables such as gender, LN class, IS treatment type, and patient outcomes, which were categorized as either \u201cstable\u201d or \u201cflare experienced\u201d, were presented as percentages and frequencies. A flare in LN was characterized by a two-fold increase in serum creatinine levels and a rise in proteinuria following the cessation of IS medication. Results: Outcomes were assessed for 45 patients with LN who ceased IS therapy after achieving remission. The patients\u2019 median age was 55 years (29\u201378). The median duration of treatment was 4 years (0.5\u201314). The LN histology distribution was class V = 24.4%, class IV = 17.8 %, class III = 17.8%, class III + IV = 15.6%, class III + V = 6.7%, class IV + V = 2.2%, and class II + IV and II = 2.2%. At the discontinuation of IS treatment, creatinine levels were elevated in 9\/45 (20%) patients. Furthermore, 28.9% of patients relapsed after IS treatment discontinuation. Patients with anti-Smith antibodies (anti-Sm) were observed to have a higher occurrence of relapses, with six patients experiencing flare compared to four patients who remained stable (p = 0.03). Five (38.5%) of the patients with flares had high creatinine levels after IS discontinuation. Conclusions: Most of our patients maintained clinical remission and stable levels of LN parameters after IS treatment discontinuation. Those with a high serum creatinine level, ongoing proteinuria, depleted complement levels, and the presence of anti-Sm antibodies were more likely to experience flares after the discontinuation of IS therapy.<\/jats:p>","DOI":"10.3390\/jcm13082211","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T07:09:28Z","timestamp":1712819368000},"page":"2211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Lupus Nephritis Outcomes after Stopping Immunosuppression"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8495-9064","authenticated-orcid":false,"given":"Fahidah","family":"Alenzi","sequence":"first","affiliation":[{"name":"Internal Medicine Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oier","family":"Ateka-Barrutia","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Donostia University Hospital, 20014 Donostia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chee","family":"Ken Cheah","sequence":"additional","affiliation":[{"name":"Louise Coote Lupus Unit, Counting House, Guy\u2019s Hospital, Guy\u2019s and St. Thomas\u2019 Hospitals, NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munther","family":"Khamashta","sequence":"additional","affiliation":[{"name":"Louise Coote Lupus Unit, Counting House, Guy\u2019s Hospital, Guy\u2019s and St. Thomas\u2019 Hospitals, NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7605-7172","authenticated-orcid":false,"given":"Shirish R.","family":"Sangle","sequence":"additional","affiliation":[{"name":"Louise Coote Lupus Unit, Counting House, Guy\u2019s Hospital, Guy\u2019s and St. Thomas\u2019 Hospitals, NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David P.","family":"D\u2019Cruz","sequence":"additional","affiliation":[{"name":"Louise Coote Lupus Unit, Counting House, Guy\u2019s Hospital, Guy\u2019s and St. Thomas\u2019 Hospitals, NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1097\/MAJ.0b013e3181907b3d","article-title":"Lupus Nephritis","volume":"337","author":"Singh","year":"2009","journal-title":"Am. 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