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Abstract Number: 305

Clinicopathologic Correlates for Activity and Damage of Lupus Nephritis in Childhood-Onset Systemic Lupus Erythematosus

Ravi Nunna1, Rina Mina1, Michael Bennett2, Shannen Nelson3, Jessica Hummel4, Prasad Devarajan2, David Witte3 and Hermine Brunner5, 1Rheumatology, Cincinnati Children's Hospital Medical Center/University of Cincinnati, Cincinnati, OH, 2Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 3Rheumatology, Cincinnati Children's Hospital, Cincinnati, OH, 4Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 5Cincinnati Children's Hospital, Cincinnati, OH

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Biomarkers, lupus nephritis and pediatric rheumatology

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Session Information

Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Pediatric Systemic Lupus Erythematosus, Pediatric Vasculitis and Pediatric Myositis

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*

Biomarker

High AI Score N=12

High CI Score N=4

High TIAI Score N=10

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

 


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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