MO261 LUPUS NEPHRITIS AND COVID-19 INFECTION

Valentinova Monova, Daniela; Monov, Simeon

BACKGROUND AND AIMS: Covid-19 infection poses a serious challenge for immune-compromised patients with autoimmune systemic diseases. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities. The aim of this study is to describe clinical characteristics of patients with lupus nephritis (LN) and Coronavirus disease 2019 (COVID-19), and to identify baseline variables associated with a severe infection requiring hospitalization. METHOD: A telephone survey investigating the impact of COVID-19 on patients with biopsy - proven LN was administered. Data extraction included diagnosis, disease activity status, demographics, occupational exposure, adherence to social distancing advise, therapy, comorbidities, and laboratory tests. Covid-19 was classified as definite diagnosis of Covid-19 disease (presence of symptomatic Covid-19 infection, confirmed by a nasopharyngeal SARS-CoV-2 polymerase chain reaction test). Comparisons between patients with or without hospitalization were performed. RESULTS: 114 patients (median age 34,9 ± 12,4 years) with LN were included in the study. All were on different doses glucocorticoids, 82 were taking hydroxychloroquine and 30 took immunosuppressants. 31 patients (26 women, 5 men) developed symptomatic COVID-19 infection - they have at least one symptom (chest pain, fever, asthenia, chills, cough, sore throat, dyspnea, headache, arthralgia, myalgia, odynophagia, diarrhea, conjunctivitis, hypo-, ageusia, hypo-, anosmia) of COVID-19 and were PCR test positive. These 31 patients prior to their COVID-19 illness were treated with methylprednisolone, 16 - with cyclophosphamide, 8 - with azathioprine, 3 – with hydroxychloroquine. Six patients (4 men, 2 women) required hospitalization - these were more frequently older and with comorbidities (cardio-respiratory illness, hypertension and other) and active LN (3 –class IV LN, 2-class V LN, 1 class III LN and 1 Class II LN, according the 2003 ISN/RPS classification). Adherence to therapy and to social distancing advise was high. The median time from onset of symptoms to hospital admission was 6 (3-11) days. The median length of stay was 12 days (8-20) days. No deaths occurred. CONCLUSION: Covid-19 is more frequent in the subgroup of LN patients without therapy with hydroxychloroquine, which might play some protective role against the most harmful manifestations of Covid-19. Male sex, previous lung disease, serum creatinine level, proteinuria, glucocorticoids use > 5 mg/day, were associated to hospitalization of patients with LN.