ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 728

A Higher Activity Index at Initial Renal Biopsy Is Associated with Rapid Progression to Renal Failure in Patients with Refractory Lupus Nephritis

Shuwei Wang1, Stacy Tanner2, Teja Kapoor3, Thania Perez4, Vivette D D'Agati5, Anca Askanase4, Robert Winchester3 and Laura Geraldino-Pardilla3, 1Rheumatology, Columbia University, College of Physicians & Surgeons, New York City, NY, 2Division of Rheumatology, Columbia University, College of Physicians & Surgeons, Winnipeg, DC, Canada, 3Rheumatology, Columbia University, College of Physicians & Surgeons, New York, NY, 4Columbia University, College of Physicians & Surgeons, New York, NY, 5Pathology & Cell Biology, Columbia University, College of Physicians & Surgeons, New York City, NY

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: ,

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: Lupus nephritis (LN) is a major cause of morbidity and mortality affecting ~50% of systemic lupus erythematosus (SLE) patients.  Up to 30% of patients with LN progress to end stage renal disease (ESRD). Blacks and Hispanics develop LN earlier and have worse prognosis compared with whites. It remains controversial whether a higher activity index (AI) at the initial renal biopsy correlates with poor renal outcomes. We sought to investigate the association between AI and progression to renal failure in refractory LN patients of predominantly black and Hispanic backgrounds.   

Methods: This study included sixty-one SLE patients meeting 1997 SLE ACR classification criteria and followed at the Columbia University Lupus Center, with a first renal biopsy performed between 1994 and 2015, and at least one subsequent biopsy due to refractory disease. Demographics, clinical, laboratory, and histopathologic characteristics were ascertained. Renal failure was defined as ESRD requiring renal replacement therapy (dialysis or transplant). Logistic regression models were constructed using STATA/SE 13.0 to evaluate for predictors of progression to renal failure within 5 years. 

Results: Of the 61 patients, 51 (84%) were female, 26 (43%) Hispanic, and 18 (30%) black. The mean age at SLE diagnosis was 26 ± 12 years (Table 1). Twenty-two patients (36%) progressed to renal failure. Fibrinoid necrosis on first renal biopsy was associated with renal failure in unadjusted [OR 4.13 (CI 1.21- 14.05), p=0.024] and multivariate analyses (adjusting for age, sex, race, and serum creatinine at time of first biopsy) [OR 4.21 (CI 1.18 – 15.05), p=0.027].  Among the 22 patients with renal failure, 11 progressed to renal failure in less than 5 years and the median time from first renal biopsy to renal failure was 4.8 years (3.5-7.9). AI on the first renal biopsy significantly predicted progression to renal failure within 5 years in unadjusted [OR 1.24 (CI 1.01- 1.51), p=0.038] and multivariate analyses (adjusting for age, sex, race, and serum creatinine at time of first biopsy) [OR 1.26 (CI 1.004 – 1.58), p=0.046]. Chronicity index was not significantly associated with rapid progression to renal failure.

Conclusion: In a predominantly Hispanic and black cohort of refractory LN patients, 36% progressed to renal failure with half of them progressing in less than 5 years. AI on the first renal biopsy was an independent predictor of faster progression to renal failure and should prompt aggressive therapy.

 

Table 1. Patient Characteristics

SLE (n=61)*

Demographics

Female

51 (84)

Age Lupus Diagnosis, years

26 ± 12

Age at First Renal Biopsy, years

29 ± 13

Race

Hispanic

26 (43)

Black

18 (30)

White

9 (15)

Asian

4 (6)

Other

4 (6)

Co-morbidities

Hypertension

22 (40)

Diabetes

3 (5)

Smoking

2 (4)

Congestive Heart Failure

2 (3)

Progression

Renal Failure (Dialysis or Renal Transplant)

22 (36)

Serum Creatinine (sCr) > 1.4 mg/dL

32 (53)

Renal Failure or sCr>1.4 mg/dL

34 (56)

   Time to Renal Failure, years

4.8 (3.5 – 7.9)

Characteristics at 1st Renal Biopsy

 

Proteinuria Prot:Cr (gm)

2.3 (1.4 – 4.4)

Serum Cr (mg/dL)

0.9 (0.7 – 1.4)

C3

56 (38 – 82)

C4

10 (6 – 12)

ds-DNA antibody titer

419 (100 – 2200)

Activity Index

8 (4 – 13)

Fibrinoid Necrosis

15 (25)

Number of Crescents

5 ± 10

Wire Loop

13 (22)

Chronicity Index

2 (0 – 3)

Lupus Nephritis Class

 

II

4 (6.6)

III

6 (9.8)

IV

15 (24.6)

V

2 (3.3)

III/V

17 (27.9)

IV/V

17 (27.9)

*Reported as mean ± standard deviation, median (interquartile range) or number (% total). C3 = Complement 3, C4 = Complement 4, ds-DNA = double stranded DNA, ESRD = End Stage Renal Disease, Prot:Cr = protein to creatinine ratio, Renal Failure = end stage renal disease or transplant

 

 

Disclosure: S. Wang, None; S. Tanner, None; T. Kapoor, None; T. Perez, None; V. D. D'Agati, None; A. Askanase, None; R. Winchester, None; L. Geraldino-Pardilla, None.

To cite this abstract in AMA style:

Wang S, Tanner S, Kapoor T, Perez T, D'Agati VD, Askanase A, Winchester R, Geraldino-Pardilla L. A Higher Activity Index at Initial Renal Biopsy Is Associated with Rapid Progression to Renal Failure in Patients with Refractory Lupus Nephritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/a-higher-activity-index-at-initial-renal-biopsy-is-associated-with-rapid-progression-to-renal-failure-in-patients-with-refractory-lupus-nephritis/. Accessed .

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