Session Information
Date: Tuesday, November 7, 2017
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Lupus nephritis (LN) is the most common organ involvement in Systemic Lupus Erythematosus (SLE). Indications of renal biopsy (RB) are deterioration of renal function and / or activity in sediment and / or proteinuria> 0.5g / 24h or urine protein: creatinine ratio (P:C ratio) > 0.5 (SEN consensus 2012). There are patients who show data of “minimal renal involvement” (MRI) without indication of RB. Our objective is to determine if these patients present clinical and analytical characteristics that allow them to differentiate from patients with LN.
Methods:
We reviewed 171 patients with SLE diagnosis, classifying them as MRI if they showed> 3 occasions at least 1 year, proteinuria determinations = 0.3 g / 24h or P:C ratio= 0.3, ruling out urologic pathology. We have compared clinical and analytical variables of MRI vs LN at the time of SLE diagnosis, at renal involvement diagnosis and last visit.
Results:
We identified 38 (18.7%) patients with MRI and 41 (24%) patients with LN. At the time of SLE diagnosis, the MRI group had a lower titer of anti-DNAds (14.8% vs 42.1%, p = 0.01), anti-Sm (12% vs 32.2%, p = 0.04), presence of lupus anticoagulant (38%, p = 0.01) and anticardiolipin IgG (11% vs 38%, p = 0.01), less severe C3 hypocomplementemia (70 ± 34 vs 86.9 ± 32.7 mg / dl, p = 0.04), C4 (14 ± 10 vs 17 (p = 0.04) and CH50 (33.3 ± 15 vs 49.6 ± 17.4 mg / dl, p = 0.04); and lower inflammatory parameters: ESR (23.1 ± 20 vs 58.9 ± 42 mg / dl, p = 0.01), CRP (12.7±11.8 vs 27.3±17 mg/dl, p=0.02). At the diagnosis of the renal involvement, these results were confirmed (Table) and we observed that, in MRI patients, proteinuria appeared at an older age, with a higher evolution of SLE (12.7 ± 11.8 vs 27.3 ± 17 mg / dl, p = 0.02) and with absence of previous immunosuppressant therapy. After a mean follow-up of 10 ± 6.6 years, no MRI patient presented a renal flare, maintaining stable the renal function.
|
|
LUPUS NEPHRITIS (n=41) |
MINIMAL RENAL INVOLVEMENT (MRI) n=38 |
p |
|
Sex (Female/Male) |
30/11 |
29/3 |
0.05 |
|
Age (years) |
38 ± 16 |
45 ± 17 |
0.07 |
|
Follow up time (years) |
3.4 ± 5.5 |
5.8 ± 4 |
0.01 |
|
Creat (mg/dl) |
1.3 ± 1.3 |
0.7 ± 0.2 |
0.02 |
|
URINE SEDIMENT
|
14 (35%) 3 (7,5%) 9 (22.5%) 14 (35%) |
32 (100%) |
NA |
|
Proteinuria (mg/24h) |
2044 ± 2700 |
266 ± 71.6 |
NA |
|
(P:C ratio) (mg/gr) |
1761,7 ±1446 |
232 ± 172 |
NA |
|
HT (n, %) |
3 (13%) |
2 (6%) |
0.6 |
|
DM2 (n, %) |
2 (8%) |
2 (6%) |
0.7 |
|
DNA-crithiida |
26 (74.3) |
9 (37.5) |
0.005 |
|
Anti-SSARO (IA) |
13 (38.2%) |
12 (38.7%) |
0.5 |
|
Anti-La (IA) |
8 (23.5%) |
5 (16.1%) |
0.3 |
|
Anti-RNP (IA) |
13 (39.4%) |
7 (24.1%) |
0.1 |
|
Anti-Sm (IA) |
13 (39.4%) |
4 (14.3%) |
0.002 |
|
C3 (mg/dl) |
70±21.9 |
130±10 |
0.001 |
|
C4 (mg/dl) |
16.1±3.9 |
26±10.8 |
0.001 |
|
C1q (mg/dl) |
16.5±11 |
26±12.3 |
0.001 |
|
CH50 (U/mL) |
34±5.3 |
71.0±15 |
0.001 |
|
Immunosuppressants
|
15 (38.5%) 20% 13% 20% |
25 (78,1%) 4% 88% 32% |
0.001 0.1 0.001 0.003 |
|
Corticosteroids |
19 (50%) |
15 (46.9%) |
0.4 |
Conclusion:
Our results showed that patients with MRI had a lower clinical and biological SLE activity, both at SLE diagnosis and at the diagnosis of renal involvement. No MRI patients presented a LN flare during the follow-up although it is difficult to know the role played by the immunosuppressant treatment.
To cite this abstract in AMA style:
Salman-Monte T, Rodriguez E, Arevalos JL, Soler MJ, Barrios C, Carbonell J, Pascual J. Minimal Renal Affection in Patients with Systemic LUPUS Erythematosus: Characteristics and Evolution [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/minimal-renal-affection-in-patients-with-systemic-lupus-erythematosus-characteristics-and-evolution/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/minimal-renal-affection-in-patients-with-systemic-lupus-erythematosus-characteristics-and-evolution/