Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: High AI activity (AI), tubulointerstitial (TI), and chronicity index (CI) scores from renal biopsy may predict poor renal outcomes in lupus nephritis (LN) in childhood-onset systemic lupus erythematosus (cSLE). Our aim is to evaluate the relationship between histologic evidence of renal disease activity and damage of LN with conventionally used biomarkers in cSLE.
Methods: Biopsy specimens of 18 cSLE patients were rated by a single nephropathologist for the AI, TI, and CI. Using logistic regression, the relationships between the biomarkers and high scores for AI (≥ 7), high CI (≥ 3), and high TI (≥ 4) were evaluated. Biomarkers evaluated include serum creatinine, creatinine clearance, urine sediment, proteinuria, albumin, blood pressure, anti-ds DNA antibody, C3, C4, sedimentation rate, and blood urea nitrogen (BUN); these were obtained on the day of renal biopsy to 30 days after.
Results: Patient’s mean age ± SD was 14.1 ± 2.7 years. LN class distribution was as follows: II (28%), III (17%), IV (50%), and III plus IV (6%). All were positive for anti-ds DNA antibody. Only elevated BUN (odds ratio=14, 95% CI=1.2-156, p-value=0.05) was significantly associated with high TI score. None of the biomarkers were significantly associated with high AI and high CI scores using cut-offs as specified above (see Table).
Conclusion: Commonly used biomarkers are poorly associated with histological features for activity and damage of LN in cSLE highlighting the need for better biomarkers that can be used in clinical care.
|
Table: Relationship of high AI, high CI, and high TI scores with conventional biomarkers* |
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|
Biomarker |
High AI Score N=12 |
High CI Score N=4 |
High TIAI Score N=10 |
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|
Odds ratio |
P-value |
Odds ratio |
P-value |
Odds ratio |
P-value |
|
|
Systolic blood pressure |
1.10 (0.98-1.17) |
NS |
1.03 (0.96-1.10) |
NS |
1.04 (0.97-1.12) |
NS |
|
Diastolic blood pressure |
1.16 (0.99-1.36) |
NS |
1.02 (0.91-1.14) |
NS |
1.02 (0.92-1.13) |
NS |
|
Hematuria (> 5 RBC/hpf) |
0.67 (0.08-5.68) |
NS |
2.22 (0.25-20.17) |
NS |
1.29 (0.16-10.45) |
NS |
|
Pyuria (> 5 WBC/hpf) |
1.00 (0.13-7.99) |
NS |
0.67 (0.08-5.68) |
NS |
1.40 (0.20-10.03) |
NS |
|
Urine protein to creatinine ratio |
2.02 (0.88-4.78)
|
NS |
27.03 (0.22-990) |
NS |
1.60 (0.87-2.95) |
NS |
|
Albumin |
0.08 (0.01-1.07) |
NS |
0.85 (0.09-7.98) |
NS |
0.38 (0.07-2.11)
|
NS |
|
C3 |
0.90 (0.12-6.78) |
NS |
0.55 (0.07-4.56) |
NS |
0.50 (0.07-3.68) |
NS |
|
C4 |
2.00 (0.11-37.83) |
NS |
0.29 (0.01-5.66) |
NS |
1.25 (0.07-23.26) |
NS |
|
Sedimentation rate |
1.00 (0.97-1.03) |
NS |
1.00 (0.97-1.03) |
NS |
0.98 (0.94-1.01) |
NS |
|
Serum creatinine |
1.09 (0.08-14.66) |
NS |
9.33 (0.62-139.51) |
NS |
1.78 (0.13-23.52) |
NS |
|
Creatinine clearance |
0.99 (0.97-1.02) |
NS |
1.00 (0.98-1.02) |
NS |
0.99 (0.96-1.01) |
NS |
|
BUN |
7.00 (0.65-75.74) |
NS |
3.00 (0.37-24.17) |
NS |
14.00 (1.25-156.61) |
0.05 |
|
*High AI (≥ 7/24), high CI (≥ 3/12), and high TI (≥ 4/21) N-number of patients, Total N=18 |
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Disclosure:
R. Nunna,
None;
R. Mina,
None;
M. Bennett,
None;
S. Nelson,
None;
J. Hummel,
None;
P. Devarajan,
None;
D. Witte,
None;
H. Brunner,
None.
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