Session Information
Date: Sunday, November 5, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster I: Biomarkers and Outcomes
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Vascular injury in lupus nephritis is often described on renal biopsy, but its clinical correlates are not well understood. Recent evidence suggests it may be associated with poorer prognosis. We retrospectively investigated clinical and laboratory characteristics associated with vascular injury on renal biopsy among patients diagnosed with lupus nephritis.
Methods: We reviewed initial renal biopsy reports performed at a single academic medical center between 1996 and 2015 showing Class II-VI lupus nephritis. Experienced pathologists interpreted the histologic findings. Vascular injury was defined as arterial or arteriolar thickening of the intima without thrombosis, necrosis or proliferation. The extent of vascular injury was described as absent, mild, moderate, or severe. Clinical variables including i) hypertension (systolic blood pressure ≥ 140mmHg or diastolic blood pressure ≥90mmHg), ii) demographics, iii) serum laboratories at the time of biopsy and iv) medications for 30 days prior to the biopsy were obtained from the medical records. We used univariable analyses and multivariable logistic regression to model risk of vascular injury on biopsy.
Results: Among 155 initial lupus nephritis biopsies 103 exhibited vascular injury. The average age was 39 years, 84% were female, 42% were African American and dsDNA was positive in 84%. ISSN lupus nephritis biopsy classes overall were 14% II, 26% III, 33% IV and 26% V, and class was not statistically associated with presence of vascular injury. There were no statistically significant differences in duration of SLE at biopsy or prior medications between biopsies with or without vascular injury (Table). Vascular injury was associated with older age [39 (±13) vs. 34 years (±11), p 0.02], elevated creatinine [1.8 vs 0.97 mg/dL, p 0.0006] and hypertension (36% vs. 19%, p 0.03] in univariable analyses. Presence of antiphospholipid antibodies and treatment with high dose glucocorticoids, immunosuppressants and ACE inhibitors at the time of biopsy did not differ between groups. Hypertension remained a strong correlate of vascular injury in a multivariable model controlling for age, race, sex and creatinine [OR 1.32 (95% CI 1.08, 1.62)].
Conclusion: Systemic hypertension was associated with vascular injury on lupus nephritis renal biopsy in this study. Further work in characterizing any differences in vascular lesions among patients with and without lupus nephritis is necessary as understanding the pathogenesis of these lesions may give insight into novel treatment pathways. These findings may support the importance of aggressive blood pressure management in patients with lupus nephritis.
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Table. Univariable Analyses of Clinical Factors Potentially Associated with Vascular Injury on 155 Initial Lupus Nephritis Biopsies |
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Vascular Injury (n= 103) |
No Vascular Injury (n=52) |
p-value* |
|
|
Age, mean |
39 (±13) |
34 (±11) |
0.02 |
|
Duration of SLE at biopsy (years), mean |
7.8 (±8) |
5.5 (7) |
0.16 |
|
Female |
87 (84%) |
45 (87%) |
0.73 |
|
Race |
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White |
32 (33%) |
18 (35%) |
0.11 |
|
Black |
41 (42%) |
12 (24%) |
|
|
Asian |
9 (9%) |
9 (18%) |
|
|
Hispanic |
15 (15%) |
10 (20% |
|
|
Other |
1 (1%) |
2 (4%) |
|
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Laboratory Values |
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Hemoglobin (g/dL), mean |
10.7 (2) |
10.7 (2) |
0.96 |
|
Anti-dsDNA (IU/mL), median |
141 [43, 454] |
254 [50, 1000] |
0.14 |
|
Anti-RNP positive |
39 (42%) |
23 (49%) |
0.4 |
|
Antiphospholipid Antibodies** |
22 (28%) |
13 (28%) |
0.98 |
|
C4 (mg/dL), mean |
14 (12) |
11 (8) |
0.26 |
|
Creatinine (mg/dL), mean |
1.8 (±2) |
0.97 (±1) |
0.0006 |
|
Clinical Data |
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Prior high dose glucocorticoids*** |
28 (31%) |
17 (35%) |
0.61 |
|
Prior immunosuppression**** |
21 (23%) |
10 (21%) |
0.73 |
|
Prior ACE Inhibitor |
29 (32%) |
18 (38%) |
0.53 |
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SBP ≥140mmHg or DBP≥ 90mmHg |
38 (36%) |
10 (19%) |
0.03 |
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SLICC score, median |
3 [1, 6] |
2.5 [1,6] |
0.14 |
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*Continuous variables evaluated with t-test or Wilcoxon and binary and categorical variables were assessed using chi-squared tests or Fisher’s exact as appropriate. ** positive vs. negative or not tested ** *glucocorticoid ≥20mg/day for past 30 days **** receiving azathioprine, cyclophosphamide, mycophenolate mofetil, rituximab, cyclosporine or tacrolimus at the time of biopsy |
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To cite this abstract in AMA style:
Leatherwood C. Systemic Hypertension Is Associated with Presence of Vascular Injury on Lupus Nephritis Renal Biopsies: A Retrospective Cohort Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/systemic-hypertension-is-associated-with-presence-of-vascular-injury-on-lupus-nephritis-renal-biopsies-a-retrospective-cohort-study/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/systemic-hypertension-is-associated-with-presence-of-vascular-injury-on-lupus-nephritis-renal-biopsies-a-retrospective-cohort-study/