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Objectives Early referral to specialized lupus clinics has been proposed to improve outcomes in systemic lupus erythematosus (SLE). This study compared clinical presentations and long-term damage outcomes of lupus nephritis (LN) between patients enrolled early in their disease course (inception cohort, =<1 year from SLE onset) and those referred later (prevalent cohort), to assess the impact of early specialized care on renal and extra-renal damage outcomes.Methods We analyzed 526 SLE patients with LN followed longitudinally at a tertiary lupus clinic. Patients were classified as inception (n = 246) or prevalent (n = 280) cohorts. Baseline demographics, renal parameters, serologies, histopathology, and treatment profiles at LN onset were compared. Primary outcomes were (1) a composite renal damage endpoint—end-stage kidney disease (ESKD) or sustained >=40% decline in eGFR, and (2) extra-renal damage, defined as any increase in the non-renal SLICC/ACR Damage Index (SDI). Cox proportional hazards models, adjusted for clinically relevant confounders and accounting for death as a competing risk, were used to assess associations between cohort status and outcomes.Results At LN onset, baseline renal function and histologic class were comparable between cohorts; however, the prevalent group showed higher chronicity index scores (median 3.0 vs. 2.0, p<0.01), and higher baseline SDI (p=0.01) ( table 1). During a median follow-up of 8.3 years [IQR, 3.8–14.4], renal damage outcomes did not differ significantly (18.9% inception vs. 22.9% prevalent, p = 0.32; median 6.9 vs. 5.8 years, p = 0.13; adjusted HR 1.05, 95% CI: 0.59–1.89) (figure 1A). For extra-renal damage, the overall frequency (41.1% vs. 39.3%, p = 0.76) and time to accrual (median 4.2 vs. 3.9 years, p = 0.64) (figure 1B) were comparable between cohorts, yet inception patients demonstrated a significantly lower adjusted risk of damage accrual (HR 0.67, 95% CI: 0.46–0.98). Musculoskeletal and ophthalmologic domains, often linked to glucocorticoid exposure, contributed most to non-renal damage.Abstract S9:05 Figure 1Abstract S9:05 Table 1Conclusions In this large, single-center LN cohort, renal outcomes were comparable between inception and prevalent patients under expert-guided care, underscoring the benefit of specialized management. Earlier referral was associated with reduced extra-renal damage, suggesting that timely multidisciplinary care may mitigate systemic complications and limit glucocorticoid-related toxicity.