Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects I - Renal, Malignancy, Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Lupus nephritis is a common and feared complication in systemic lupus erythematosus (SLE). Clinicians have relied on different variables to help to predict those subjects who will eventually develop a kidney function deterioration. Our objective was to identify those variables associated with a double increase in serum creatinine in biopsy proven lupus nephritis (LN).
Methods:
All patients fulfilled ACR criteria for SLE. We identified 49 cases with biopsy proven lupus nephritis. Clinical charts were reviewed by a single trained rheumatologist following predefined criteria for different variables recorded when the biopsy was performed including clinical, laboratory, immunologic and histological information. All biopsies were evaluated by a single qualified and experienced pathologist who scored activity and chronicity indices. Forty nine patients were identified. Ten of them doubled their creatinine in their follow-up. These subjects were compared with the other thirty nine patients using chi square or Mann Whitney U test. In all cases significance was set at 0.05 alfa level. Odds ratio and 95% confidence intervals were also calculated.
Results:
Mean age of onset of SLE was 30.1 +/-12 years, and mean age onset of LN was 32.5 +/-12 months. . Main reasons for a first renal biopsy were persistent urine abnormalities (27 patients), proteinuria (17 ), nephritic syndrome (4 ) and acute renal failure (1). Histologic diagnosis (WHO criteria) were type IV (22/44%), II (14/28%), III (10/20%), V (2/10), VI (1/2%). Our study did not found significant relationship between double increase in serum creatinine and type of biopsies, but activity and chronicity index showed a clear trend almost reaching statistical significance. Other variables are presented in table 1.
Table 1
|
Variable |
Doubled creatinine (n:10) |
Not doubled creatinine (n:39) |
OR 95%CI |
p value |
|
Age (Mean/SD) |
24/9 |
31/11 |
|
0.06 |
|
HBP* |
10 |
24 |
7 (0.8-59) |
0.02 |
|
Serositis |
7 |
11 |
5.9 (1.2-27) |
0.02 |
|
Edema |
10 |
24 |
7 (0.8-59) |
0.02 |
|
Lymphopenia |
10 |
23 |
7.7 (0.9-66) |
0.01 |
|
APLA (+)** |
6 |
8 |
5.8 (1.3-25) |
0.02 |
|
Activity Index |
9.8/5.9 |
6/4.9 |
|
0.06 |
|
Chronicity Index |
2.7/2.4 |
1.4/1.7 |
|
0.06 |
*HBP: High blood pressure
** Positive anticardiolipin antibodies
Conclusion:
A subgroup of clinical, laboratory and histologic variables were identified as predictors to double creatinine in biopsy proven lupus nephritis. However increasing anti-double-stranded DNA antibody and hypocomplementemia no showed statistical significance as in previous studies. These can be useful to increase clinical surveillance in these patients.
Disclosure:
R. Menor Almagro,
None;
M. H. Cardiel,
Pfizer, BMS, Roche, Amgen, Lilly, Astellas,
2,
Pfizer, BMS, Amgen, Lilly,
5,
Pfizer, Lilly,
8;
J. Rubio Garrido,
None;
J. L. de la Iglesia,
None;
J. J. Perez Venegas,
None;
M. M. Ruiz Tudela,
None;
J. J. Salaberri,
None;
M. Paez-Camino,
None.
ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-a-double-increase-in-serum-creatinine-in-biopsy-proven-lupus-nephritis-from-a-single-center-in-spain/