Session Information
Date: Sunday, October 21, 2018
Title: Systemic Lupus Erythematosus – Clinical Poster I: Clinical Manifestations and Comorbidity
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Cardiovascular disease (CVD) is significantly accelerated in young systemic lupus erythematous (SLE) patients including those with lupus nephritis (LN). Despite literature suggesting that renal arteriosclerosis is an early predictor of CVD, presence of arteriosclerosis is often overlooked in LN biopsies. Hence, we aimed to examine the prevalence of renal arteriosclerosis in kidney biopsies of LN patients by age group and in comparison to published rates in healthy adult kidney donors. We hypothesized that renal arteriosclerosis burden will be greater and will accelerate at a younger age in LN patients compared to healthy donors.
Methods:
Our cohort study identified all consecutive LN patients who underwent kidney biopsy between 1994 and 2017 at an academic center. Data were abstracted from a comprehensive native renal biopsy database including sociodemographics and reported details regarding the first biopsy in SLE patients. SLE diagnosis was validated using SLICC 2012 and SLE duration was recorded from electronic health records. Biopsy reports were reviewed for LN class and chronicity as classified per International Society of Nephrology guidelines. The primary outcome of interest, renal arteriosclerosis (without arteritis or thrombi) was classified into four categories based on BANFF criteria for donor kidney biopsies: none, mild, moderate, severe. Prevalence of (A) any renal arteriosclerosis and (B) moderate-severe arteriosclerosis was calculated. Further, we compared predictors of the presence of any renal arteriosclerosis (vs. absence) using multivariate logistic regression.
Results:
Among 189 incident LN patients with kidney biopsies, 78% were female, 78% white and median age was 25 years (2-79 years). Prevalence of any renal arteriosclerosis and moderate-severe renal arteriosclerosis was 31.8% and 7.4% respectively in LN patients (Table 1). Respective rates of 51.7% (any) and 10.8% (mod-severe) in ages 40-49 were comparable to healthy kidney donors ages 70-79.
Univariate analysis in LN patients showed that age, chronicity and ever smoking were positive predictors of renal arteriosclerosis. Multivariate analysis showed a peak of 11 times greater odds of renal arteriosclerosis in LN patients ages 40-49 compared to younger patients (OR 11.7,CI 1.6, 246.0), and chronicity predicted nearly three times greater odds of arteriosclerosis (OR 2.9, CI 1.2, 7.1). LN class and SLE duration were not predictors of arteriosclerosis.
Conclusion:
Findings showed significantly greater burden of renal arteriosclerosis in LN patients two to three decades earlier than in healthy kidney donors. Quantifying renal arteriosclerosis burden in LN is important as a potential early predictor of CVD in SLE. Future work will compare prevalence and predictors of renal arteriosclerosis in SLE, vasculitis and non-glomerulonephritis biopsies and long-term CVD outcomes.
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Table 1. Prevalence of Any or Moderate-Severe Arteriosclerosis in LN by Age Groups |
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|
Age groups |
Prevalence Any arteriosclerosis |
Prevalence Moderate-severe |
Control Prevalence* (Any, Moderate-severe) |
|
Overall (n=189) |
31.8% |
7.4% |
(32%,3.3%) |
|
0-9 years (n=16 ) |
6.3% |
6.3% |
NA |
|
10-19 years (n=66) |
22.2% |
0 |
NA |
|
20-29 years (n=33) |
17.9% |
0 |
(10%,0%)* |
|
30-39 years (n=17) |
35.3% |
11.8% |
(19%,2%) |
|
40-49 years (n=29) |
51.7% |
10.8% |
(37%,2.3%) |
|
50-59 years (n=12) |
59.0% |
25.0% |
(44%,7%) |
|
60-69 years (n=12) |
66.7%% |
33.3% |
(51%,6.5%) |
|
70-79 years (n=4) |
50.0% |
25.0% |
(82%,9.1%) |
|
*Comparator group ages 18-29. Control data source: Rule et al Ann Intern Med. 2010 May 4; 152(9): 561–7 |
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To cite this abstract in AMA style:
Garg S, Panzer S, Semanik M, Bartels CM. The Burden of Renal Arteriosclerosis in Lupus Nephritis: A Cohort Study Examining Prevalence and Predictors of Renal Arteriosclerosis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-burden-of-renal-arteriosclerosis-in-lupus-nephritis-a-cohort-study-examining-prevalence-and-predictors-of-renal-arteriosclerosis/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-burden-of-renal-arteriosclerosis-in-lupus-nephritis-a-cohort-study-examining-prevalence-and-predictors-of-renal-arteriosclerosis/