Characterization of Patients with Lupus Nephritis Included in a Large Cohort from the Spanish Society of Rheumatology Registry of Patients with Systemic Lupus Erythematosus

María Galindo Izquierdo¹, Esther Rodriguez-Almaraz¹, Sabina Perez², José M. Pego-Reigosa³, Jaime Calvo-Alen⁴, Francisco Javier López-Longo⁵, Iñigo Rúa-Figueroa⁶, Alejandro Olivé⁷, Víctor Martínez Taboada⁸, Paloma Vela Casasempere⁹, Mercedes Freire¹⁰, Javier Narváez¹¹, Antonio Fernandez Nebro¹², Jose Rosas¹³, Monica Ibanez Barcelo¹⁴, Esther Uriarte¹⁵, Eva Tomero¹⁶, Antonio Zea¹⁷, Maria Loreto Horcada¹⁸, Vicente Torrente¹⁹, Ivan Castellvi²⁰, Joan Calvet²¹, Raúl Menor Almagro²², Mª Angeles Aguirre²³, Enrique Raya²⁴, Elvira Diez Alvarez²⁵, Tomás Vázquez Rodríguez²⁶, Paloma García de la Peña²⁷, Atusa Movasat²⁸, José Luis Andreu²⁹, Patricia Richi³⁰, Carlos Marras Fernandez-Cid³¹, Carlos Alberto Montilla Morales³², Blanca Hernández-Cruz³³, José Luis Marenco de la Fuente³⁴, Marian Gantes³⁵, Eduardo Ucar³⁶, Juan J. Alegre³⁷, Javier Manero³⁸, Jesús Ibañez Ruán³⁹, Manuel Rodríguez-Gómez⁴⁰, Victor Quevedo⁴¹, José Hernández Beiraín⁴² and Lucía Silva Fernández⁴³, ¹Department of Rheumatology. Hospital Universitario 12 de Octubre, Madrid, Spain, ²Sociedad Española de Reumatología, Research Unit,, Madrid, Spain, ³Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain, ⁴Rheumatology Division, Sierrallana Hospital, Torrelavega, Spain, ⁵Rheumatology, Hospital Gregorio Marañon, Rheumatology, Hospital Gregorio Marañon, Madrid, Spain, ⁶Rheumatology, Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain, ⁷Rheumatology, Hospital Universitario Germans Trias i Pujol, Badalona, Spain, ⁸Rheumatology, Marqués de Valdecilla, Santander, Spain, ⁹Hospital General de Alicante, Alicante, Spain, ¹⁰Rheumatology, Hospital Universitario Juan Canalejo, La Coruña, Spain, ¹¹Rheumatology, Hospital Universitario de Bellvitge. Barcelona. Spain, Barcelona, Spain, ¹²Rheumatology, Hospital Regional Carlos Haya, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain, ¹³Rheumatology, Hospital Marina Baixa. Villajoyosa, Villajoyosa, Spain, ¹⁴H. Son Llatzer, Palma de Mallorca, Spain, ¹⁵Rheumatology, Hospital de Donosti, San Sebastian, Spain, ¹⁶Rheumatology, Hospital Universitario de La Princesa. IIS La Princesa, Madrid, Spain, ¹⁷Rheumatology, Hospital Universitario Ramon y Cajal, Madrid, Spain, ¹⁸Rheumatology, Complejo Hospitalario de Navarra, Pamplona, Spain, ¹⁹Rheumatology, Hospital Moisès Broggi, Barcelona, Spain, ²⁰Unitat de Reumatologia., Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, ²¹Hospital Parc Taulí, Barcelona, Spain, ²²Rheumatology, Hospital de Jerez, Jerez de la Frontera, Spain, ²³Rheumatology, IMIBIC-Reina Sofia Hospital, Cordoba, Spain, ²⁴Rheumatology, University Hospital San Cecilio, Granada, Spain, ²⁵Rheumatology, Leon Hospital, Leon, Spain, ²⁶Rheumatology, Hospital Lucus Augusti, Lugo, Spain, ²⁷Rheumatology, Hospital Norte Sanchinarro, Madrid, Spain, ²⁸Hospital Príncipe de Asturias, Immune System Diseases/Rheumatology department, Alcalá de Henares, Madrid, Spain, ²⁹Rheumatology, Hospital Puerta de Hierro, Madrid, Spain, ³⁰Hospital Infanta Sofía, Madrid, Spain, ³¹C/ Salvia 11, H. Arrixaca, Alicante, Spain, ³²Rheumatology Department, Hospital Virgen de la Vega, Salamanca, Spain, ³³Rheumatology, University Hospital Virgen Macarena, Sevilla, Spain, ³⁴Hospital de Valme. Sevilla, Sevilla, Spain, ³⁵Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain, ³⁶Hospital de Basurto, Rheumatology, Bilbao, Spain, ³⁷Rheumatology, Hospital Universitario Dr Peset, Valencia, Spain, ³⁸Ophthalmology and Rheumatology. Hospital Miguel Servet Zaragoza, Spain, Zaragoza, Spain, ³⁹POVISA, Rheumatology, Vigo, Spain, ⁴⁰Rheumatology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain, ⁴¹Rheumatology, Hospital de Monforte, Lugo, Spain, ⁴²Rheumatology, Hospital Insular de Gran Canaria, Las palmas Gran Canarias, Spain, ⁴³Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Epidemiologic methods, Nephritis, outcomes, registry and systemic lupus erythematosus (SLE)

Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Biomarker, Translational and Nephritis Studies

Session Type: Abstract Submissions (ACR)

Background/Purpose

To describe the profile of patients included in RELESSER with histologically confirmed lupus nephritis (LN).

Methods RELESSER is a multicentre cross-sectional study, with information retrospectively collected from the charts of patients with SLE followed up at participant rheumatology units. Globally, 359 variables including demographic and clinical data, activity, severity, comorbidities, treatments and mortality were recorded. The following renal data were included: WHO LN histological type, proteinuria, haematuria, leukocyturia, cellular casts and creatinine clearance, treatment response, recurrence, development of ESRD and/or the need for dialysis or renal transplantation. We performed a descriptive analysis by calculating means ± SD for numerical variables and frequencies for qualitative variables. Chi-square or t-Student tests were applied to analyse their relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. Statistical significance was p<0.05.

Results

LN was confirmed in 1092 patients (31%). Most patients were female (86%), Caucasian (90%), and the mean age at disease onset was 33±14 years. Most patients developed LN in the first year after SLE diagnosis. Most had LN proliferative forms (70%), and there were only 16 cases of thrombotic microangiopathy (TMA). The risk of LN development was significantly lower among women (p<0.001), and higher as lower was the age of the disease onset and among hispanic ethnicity (p<0.001). Complete response to treatment was achieved in 68.3% of patients, whereas 17.9% remained with renal activity. A higher risk for persistence of renal activity was found with higher levels of baseline serum creatinine (1 vs 0.91, p=0.004) and proteinuria (2.76 vs 2.4, p=0.006). ESRD was clinically associated with positive a-dsDNA, low complement, pleuropericarditis, seizures (all p<0.001), and haemolytic anemia (p=0.015).TMA was a risk factor for ESRD, and the necessity of dialysis or renal transplantation (all p<0.05).ESRD was an independent mortality risk factor (p<0.001).326 recurrences were recorded, with a mean time to first recurrence of 47 months (0-28),regardless of histology.The lower was the serum creatinine and older was the age at LN onset,the lower was the recurrence risk.TMA was a risk factor for recurrence (p=0.016). Recurrences were related with persistent lupus activity and ESRD (both, p<0.001). During the follow up, the LN development associations are described in Table 1. LN was a poor prognostic factor associated with increased mortality risk OR 2.4 (1.81-3.22), p<0.001.

Table 1.

OR (CI)

Malar rash

Pleurisy

Pericarditis

Alveolar and interstitial lung disease:

Alveolar hemorrhage

Seizures

Psychosis

Haemolytic anemia

Leukolymphopenia

Thrombocytopenia

a-dsDNA

a-Sm

Antiphospholipid syndrome:

lupus anticoagulant

arterial/venous thrombosis

Low complement levels

1.54 (1.33-1.78)**

1.95 (1.66-2.29)**

2.07 (1.73-2.50)**

1.73 (1.23-2.44)*

3.56 (1.77-7.19)**

2.40 (1.84-3.13)**

1.88 (1.20-2.94)*

2.39 (1.89-3.03)**

1.38 (1.19-1.61)**

1.49 (1.26-1.76)**

4.77 (3.82-5.95)**

1.73 (1.45-2.05)**

1.57 (1.29-1.92)**

1.28 (1.06-1.55)*

1.84 (1.35-2.51)**/ 1.60 (1.27-2.01)**

4.48 (3.53-5.68)**

*: p<0.05; **: p<0.001

Conclusion

LN, mainly proliferative forms, affects almost one third of patients with SLE,and is often associated with the occurrence of other severe lupus manifestations, being a poor prognostic factor. TMA and relapses are associated with worse outcome in renal function.

Disclosure:

M. Galindo Izquierdo,
None;

E. Rodriguez-Almaraz,
None;

S. Perez,
None;

J. M. Pego-Reigosa,

Governmental research grant,

European Union Research grant,

J. Calvo-Alen,

MSD, GlaxoSmithKline, Eli Lilly,

F. J. López-Longo,
None;

I. Rúa-Figueroa,
None;

A. Olivé,
None;

V. Martínez Taboada,
None;

P. Vela Casasempere,
None;

M. Freire,
None;

J. Narváez,
None;

A. Fernandez Nebro,
None;

J. Rosas,
None;

M. Ibanez Barcelo,
None;

E. Uriarte,
None;

E. Tomero,
None;

A. Zea,
None;

M. L. Horcada,
None;

V. Torrente,
None;

I. Castellvi,
None;

J. Calvet,
None;

R. Menor Almagro,

Abbvie,

M. A. Aguirre,
None;

E. Raya,
None;

E. Diez Alvarez,
None;

T. Vázquez Rodríguez,
None;

P. García de la Peña,
None;

A. Movasat,
None;

J. L. Andreu,
None;

P. Richi,
None;

C. Marras Fernandez-Cid,
None;

C. A. Montilla Morales,
None;

B. Hernández-Cruz,
None;

J. L. Marenco de la Fuente,
None;

M. Gantes,
None;

E. Ucar,
None;

J. J. Alegre,
None;

J. Manero,
None;

J. Ibañez Ruán,
None;

M. Rodríguez-Gómez,
None;

V. Quevedo,
None;

J. Hernández Beiraín,
None;

L. Silva Fernández,
None.

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/characterization-of-patients-with-lupus-nephritis-included-in-a-large-cohort-from-the-spanish-society-of-rheumatology-registry-of-patients-with-systemic-lupus-erythematosus/