ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1650

Prevalence and Prognostic Implications of IgG4 in Membranous Lupus Nephritis

David Herrera Van Oostdam1, Marco Ulises Martinez-Martinez1, Cuauhtémoc Oros-Ovalle2, David Martínez-Galla2, Gerardo Tonatiu Jaimes-Piñón1, Natalia Alemán-Sánchez2 and Carlos Abud-Mendoza1, 1Unidad de Investigaciones Reumatológicas, Hospital Central & Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico, 2Patología, Hospital Central & Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment: Biomarker, Translational and Nephritis Studies

Session Type: Abstract Submissions (ACR)

Background/Purpose:  Patients with membranous lupus nephritis (MLN) have increased risk of thrombosis and different prognosis than other classes of lupus nephritis (LN). Previous studies demonstrated an association of idiopathic membranous nephropathy with IgG4+ against A2-phospholipase receptor.  Scarce studies evaluate this fact in LN. To determine the prevalence of IgG4 deposits in renal biopsies of patients MLN (pure or combinations with proliferative LN). A secondary objective was to establish the prognosis of patients with IgG4 deposits.

Methods:  Cross-sectional study. We included patients with LN class V or combination (classes V+III or V+IV) according to the 2004 ISN/RPS criteria. All patients with a kidney biopsy from January 1st 2008 to January 30th 2013 were included; all samples were stained with IgG4 using antibody anti-IgG4 (MRQ44, Cell Marque).  

Results: We included 65 renal biopsies: 24 class IV+V, 23 class V, and 18 class III+V; 6/65 were IgG4 +. Patients with IgG4+ had a median age of 36 years (IQR 26yr), median of SLEDAI 8 (IQR 4) vs 12 in IgG4- (IQR 8; p 0.7). Patients with IgG4+ had median blood eosinophil count of 70 (IQR 171) vs IgG-  0 (IQR 30; p 0.03). IgG4 deposits were associated with plasmatic cell infiltration in renal biopsy (OR 42, IC 95% 2.4-228; p 0.03). All patients with IgG4+ had renal involvement as the first manifestation of SLE.  Treatment: 28% of IgG4+ and 41% of IgG4- of patients received methylprednisolone pulses before renal biopsy, since their first manifestation was a rapidly progressive glomerulonephritis. Renal failure (GFR <60 ml/min) was similar in both groups (43% in IgG4+ and 42% in IgG4-). Fifty percent of patients with IgG4+ who required dialysis at baseline still continued this therapy at 12 months vs 8% of IgG4- patients.

Conclusion: The prevalence of IgG4 deposits in MLN was 10%. All patients who had MLN as their first SLE manifestation were IgG4 +. Patients with IgG4 +LN showed worse prognosis.

Disclosure:

D. Herrera Van Oostdam,
None;

M. U. Martinez-Martinez,
None;

C. Oros-Ovalle,
None;

D. Martínez-Galla,
None;

G. T. Jaimes-Piñón,
None;

N. Alemán-Sánchez,
None;

C. Abud-Mendoza,
None.

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