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Abstract Number: 2838

Histopatholgic Predictors of Poor Renal Outcomes in a Multi-Ethnic Cohort

Stacy Tanner1, Dominick Santoriello2, Shanthi Dhaduvai3, Thania Perez4, Anca D. Askanase5 and Laura Geraldino-Pardilla6, 1Division of Rheumatology, Columbia University College of Physicians & Surgeons, New York, NY, 2Renal Pathology, Columbia University College of Physicians & Surgeons, New York, NY, 3Rheumatology, Carilion Clinic, Roanoke, VA, 4Columbia University College of Physicians & Surgeons, New York, NY, 5Department of Medicine, Rheumatology, Columbia University College of Physicians & Surgeons, New York, NY, 6Columbia University College of Physicians & Surgeons, new york, NY

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: histopathologic, lupus nephritis and renal disease

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Session Information

Date: Tuesday, November 15, 2016

Session Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster III: Biomarkers and Nephritis

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Lupus nephritis (LN) remains an important cause of morbidity and mortality in patients with SLE.  Tubular atrophy and interstitial fibrosis on initial renal biopsies in Blacks with LN have been associated with poor renal outcomes. This study was initiated to evaluate the histopathologic predictors of poor renal outcomes on initial and subsequent renal biopsies in patients with lupus nephritis in a predominantly Hispanic and Black cohort.

Methods: All SLE patients with two or more renal biopsies performed at CUMC between 1996-2015 were identified from the pathology database; data on 63 patients with regular follow-up at the Columbia University Lupus Center were available for analysis.   Demographics, clinical, laboratory and histopathologic characteristics were ascertained. Adverse renal outcomes were defined as a serum creatinine >1.4 mg/dL, ESRD, or renal transplant. Tubular atrophy and interstitial fibrosis was graded by the renal pathologist from mild (10-25% involvement) to severe (>60% involvement).  The histopathologic predictors of adverse renal outcomes were evaluated using logistic regression, adjusting for pertinent confounders.

Results: Of the 63 patients, 87% were female, 46% Hispanic, 29% Black. The average age at SLE diagnosis was 27±12, the median time from the first renal biopsy to the occurrence of the first adverse renal outcome was 6 years (4-9) (Table 1). Fifty-three percent of patients with ≥ 2 biopsies had an adverse renal outcome: 31% developed ESRD (of which 58% received a renal transplant), and 22% had a serum creatinine >1.4 mg/dL. The degree of tubular atrophy and interstitial fibrosis (TAIF) in the second renal biopsy [OR 3.5 (CI 1.3-10.6) p=0.03] but not in the first [OR 2.5, (CI 0.7-8.2); p=0.15], was a strong predictor of adverse renal outcomes in a multivariate analysis, after adjusting for hypertension, smoking, race/ethnicity, LN class and activity index. Chronicity index was not a significant predictor of renal outcome in multivariable analysis.  All subjects with severe TAIF on the second and third renal biopsies met the primary outcome. Fibrinoid necrosis, number or type of crescent, number of sclerotic glomeruli and degree of foot process effacement were not significantly associated with a poor renal outcome.

Conclusion: Fifty-three percent of SLE patients that required a second renal biopsy for LN flare in this predominantly Hispanic and Black cohort had adverse renal outcomes within 6 years; 31% developed ESRD.  Tubular atrophy and fibrosis were strong predictors of poor renal outcome. Their presence on a second biopsy should prompt intensification of therapy in patients with lupus nephritis to avoid ESRD and adverse renal outcomes.

Biopsy #1 (n=63) Biopsy #2 (n=63) Biopsy#3 (n=18)
Age at Biopsy, years 30 ± 14 34 ± 14 31 ± 9
Year of Biopsy 2005 (1999-2010) 2008 (2005-2012) 2009(2007-2011)
No. Glomeruli in Sample 18 (14-28) 19 (13-23) 21 (14-25)
LN Class Biopsy
    II, n (%) 4 (1) 2 (3) 0
    III, n (%) 7 (11) 5 (8) 1 (6)
    IV, n (%) 16 (25) 18(29) 4 (22)
    V, n (%) 2 (3) 3 (5) 0
    III/V, n (%) 17 (27) 13 (21) 1 (5)
    IV/V, n (%) 17 (27) 21 (34) 12 (67)
Activity Index 9 (4-14) 10 (4-13) 8 (5-12)
Chronicity Index 2 (0-4) 3 (2-6) 6 (4-8)
Proteinuria (gm) 2.2 (1.4-4.1) 2.4 (1.3-4) 4.9 (2-6)
Creatinine (mg/dL) 0.9 (0.7-1.4) 1.0 (0.8-2.0) 2.6 (1.4-5.2)
C3 56 (37-77) 67 (46-95) 54 (31-80)
C4 9 (6-12) 13 (7-19) 12 (7-20)
dsDNA 365 (100-2140) 433 (46-2050) 184 (98-754)
Degree Foot Process Effacement 70 (40-90) 80 (60-95) 90 (65-90)
Fibrinoid Necrosis, n (%) 16 (26) 11 (18) 4 (22)
Total # Crescents 5±10 4±6 8±6
      -Fibrous 5±10 2±3 4±5
      –Fibrocellular 1±1 1±2 1±2
      -Cellular 4±7 2±5 4±6
Wire Loop 13 (21) 20 (32) 10 (56)
Tubulointerstitial Atrophy/Fibrosis
      -None, n (%) 24 (39) 6 (10) 0
      -Mild, n (%) 29 (47) 36 (59) 11 (61)
      -Mod, n (%) 9 (14) 11 (18) 5 (28)
      -Severe, n (%) 0 8 (13) 2 (11)
Sclerotic Glomeruli 2±3 4±4 6±6

Disclosure: S. Tanner, None; D. Santoriello, None; S. Dhaduvai, None; T. Perez, None; A. D. Askanase, None; L. Geraldino-Pardilla, None.

To cite this abstract in AMA style:

Tanner S, Santoriello D, Dhaduvai S, Perez T, Askanase AD, Geraldino-Pardilla L. Histopatholgic Predictors of Poor Renal Outcomes in a Multi-Ethnic Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/histopatholgic-predictors-of-poor-renal-outcomes-in-a-multi-ethnic-cohort/. Accessed December 13, 2019.
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