Session Information
Date: Sunday, November 5, 2017
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster I: Biomarkers and Outcomes
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Moderate-to-severe tubulointerstitial damage (TID) is associated with poor renal outcomes in lupus-related kidney disease, independent of glomerular pathology1. Unlike glomerular damage, TID is not associated with anti-dsDNA or complement levels and no serologic parameters associated with TID in SLE have been identified to date 2. The presence of anti-Ro/La antibodies in Sjögren’s syndrome is associated with extraglandular manifestations, including tubulointerstitial nephritis3. Whether anti-Ro/La antibodies are associated with TID in lupus-related kidney disease has not been studied.
Objective: To study an association between anti-Ro/La antibodies and TID in lupus nephritis (LN).
Methods: We identified all patients who fulfilled ACR and/or SLICC criteria for SLE at a large urban tertiary care center. Medical history, demographic and laboratory data were ascertained from chart review. Patients were included if they had an index renal biopsy consistent with LN between January 2005 and July 2015 and had complete data on TID and anti-Ro/La. All biopsies were reviewed by 2 experienced renal pathologists and TID was classified as mild, moderate or severe when tubular atrophy and/or interstitial fibrosis involved <25%, 25-50% or >50% of the interstitium, respectively1.
Results: Of the 157 LN patients, 39 (25%) had moderate/severe TID (Table). Moderate/severe TID was associated with older age, proliferative LN (class III/IV±V) and lower estimated glomerular filtration rate (eGFR) at biopsy. Anti-Ro/La were present in 11/118 (9%) with none/mild TID vs 11/39 (28%) with moderate/severe TID (p=0.003), and in 13/114 (11%) with none/mild TII vs. 8/37 (22%) with moderate/severe TII (p=0.12). In the logistic regression model adjusted for age, eGFR and LN class, dual positivity for anti-Ro/La antibodies was associated with a 3-fold increase in the odds of TID, OR 3.1, 95% CI (1.1-9.1), p=0.04.
Conclusion: Dual anti-Ro/La positivity is associated with moderate/severe TID in patients with biopsy proven LN after adjusting for age, LN class and eGFR. The presence of only anti-Ro antibodies is not associated with moderate/severe TID. Understanding the role of anti-Ro/La in the mechanisms underlying TID in LN may lead to novel preventive and therapeutic strategies.
References:
1. Yu F, et al. Kidney Int 2010;77:820-9.
2. Hsieh, et al. Arthritis Care Res 2011; 63(6):865-74
3. Francois H, et al. Nat Rev Nephrol 2016;12(2):82-93.
|
Baseline characteristics by TID (none/mild vs. moderate/severe) |
|||
|
|
None/Mild TID (n=118) |
Moderate/Severe TID (n=39) |
p- value |
|
Age, median (IQR), years |
26 (17, 37) |
41 (25, 53) |
<0.001 |
|
Men, n(%) |
21 (18) |
10 (26) |
0.29 |
|
Black Race, n(%) |
55 (47) |
22 (56) |
0.29 |
|
Charlson comorbidity index, median (IQR) |
3 (1, 4) |
3(1, 4) |
0.09 |
|
Creatinine (mg/dL), median (IQR) |
0.8 (0.6, 1.2) |
1.6 (1, 2.6) |
<0.001 |
|
eGFR mL/min/1.73m2, median (IQR) |
91 (61, 127) |
42 (26, 75) |
<0.001 |
|
Protein/Creatinine ratio (mg/mg), median (IQR) |
2.2 (1.0, 4.9) |
2.1 (1.5, 5.5) |
0.68 |
|
LN class n(%) |
|
|
|
|
I/II |
10 (9) |
0 |
|
|
III/IV ± V |
71 (61) |
34 (87) |
0.008 |
|
V |
35 (30) |
5 (13) |
|
|
Low C3, n(%) |
83 (75) |
23 (70) |
0.51 |
|
Low C4, n(%) |
76 (70) |
22 (67) |
0.69 |
|
Elevated dsDNA, n(%) |
70 (68) |
21 (66) |
0.81 |
|
Anti-Ro, n(%) |
55 (47) |
17 (44) |
0.74 |
|
Anti-Ro and anti-La, n(%) |
11 (9) |
11 (28) |
0.003 |
|
Tubulointerstitial inflammation (TII), n(%) |
19 (17) |
18 (49) |
<0.001 |
To cite this abstract in AMA style:
Londono Jimenez A, Mowrey W, Broder AR. The Presence of Anti-Ro and Anti-La Antibodies Is Associated with Tubulointerstitial Damage in Lupus Nephritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-presence-of-anti-ro-and-anti-la-antibodies-is-associated-with-tubulointerstitial-damage-in-lupus-nephritis/. Accessed .« Back to ACR/ARHP Annual Meeting 2017
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-presence-of-anti-ro-and-anti-la-antibodies-is-associated-with-tubulointerstitial-damage-in-lupus-nephritis/