Session Information
Title: Systemic Lupus Erythematosus - Clinical Aspects I - Renal, Malignancy, Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Lupus nephritis (LN) remains one of the most serious manifestations of systemic lupus erythematosus (SLE) and is associated with significant morbidity and mortality. Early and accurate detection of kidney involvement in SLE improves outcomes. Although renal biopsy is required for proper diagnosis of the histopathological subtype of LN and direction of proper treatment, the decision to recommend renal biopsy can be complex. We aimed to investigate whether SLE patients with insignificant proteinuria have significant renal involvement and need to be biopsied. We also studied the relation between severity of nephritis and the overall disease activity and other lupus manifestations.
Methods:
Forty SLE patients with proteinuria <500 mg/24 hrs were recruited from Ain Shams University Hospitals. Disease activity was assessed according to SLE disease activity index (SLEDAI). Renal biopsy was done to all patients and assessed by light, immunofluorescent and electron microscopy for identification of different pathological classes according to WHO classification. Patients were classified into two groups: Group A: with mild renal affection [class I or II according to WHO-histopathological classification of renal biopsy] and Group B: with moderate to severe renal affection [class III, or more according to WHO classification].
Results:
All patients (100%) had lupus nephritis by histo-pathological examination according to the WHO classification. About 32.5% of SLE patients with insignificant proteinuria had mild lupus nephritis and 67.5% had moderate to severe nephritis. In Group A: 2 patients (5 %) had class I LN and 11 patients (27.5 %) had class II LN, while in Group B: 13 patients (32.5%) had class III LN, 10 patients (25 %) with class IV LN and 4 patients (10%) with class V LN. Comparing clinical characteristics of both groups; patients with severe LN (Group B) had higher SLEDAI scores (P= 0.049), higher ESR levels, higher Anti-dsDNA titer (P= 0.020) and lower C3 and C4 levels (P= 0.028 and <0.001 respectively). As well, they were more anemic, leucopenic, lymphopenic and thrombocytopenic than patients with mild LN (group A) (P= 0.020, P= 0.005, P= <0.001and P= 0.050 respectively).
Urinary abnormalities; especially proteinuria and hematuria were significantly higher in patients with severe LN than those with milder LN (P= 0.009 and 0.047 respectively). Furthermore, patients with severe LN had significant polyarthralgia and history of recurrent thrombosis than those with mild LN (P =0.011 and 0.035 respectively).
Conclusion:
We found significant renal involvement (Class III, IV, or V LN) in SLE patients with insignificant proteinuria. Our data suggest that for better outcome; renal biopsy should be justified in SLE patients with low proteinuria and without clinical signs of renal affection, especially if they have any of the following: polyarthlralgia, recurrent thrombosis, high Anti-dsDNA titer, consumed C3 &/or C4, rising ESR, high SLEDAI scores, anemia, leukopenia, lymphopenia, thrombocytopenia, and finally active urinary sediment; especially hematuria.
Disclosure:
A. A. M. Al-Hefny,
None;
S. El-bakry,
None;
S. A. Mobasher,
None;
O. H. Nada,
None;
N. Abaza,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/renal-biopsy-findings-in-lupus-patient-with-insignificant-proteinuria-relation-to-disease-activity-and-clinical-manifestations/