FRI0274 Morfological indexes in lupus nephritis – do they have prognostic value?. (15th June 2017)

• Record Type: Journal Article
• Authors: Navarro, D; Ferreira, AC; Viana, H; Carvalho, F; Nolasco, F
• Is Part Of: Annals of the rheumatic diseases. Volume 76(2017)Supplement 2
• Page Start: 590
• Page End: 590
• Publication Date: 2017-06-15
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2017-eular.3816
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus (SLE). With current therapies, a high remission rate is observed, this being the most important prognostic factor. Currently, therapy is guided by findings in the renal biopsy, following the ISN/RPS classification. Although recommended by EULAR, Austin and Hill's morphological indexes are not routinely obtained. Objectives: To analyze the importance and applicability of the different morphological indexes in predicting response to treatment and prognosis. Methods: Retrospective single center study of consecutive SLE and biopsy proven LN patients, diagnosed from 2010 to 2016. We evaluated the following outcomes: clinical remission, renal function and proteinuria at end of follow-up (FUP) (g/24h). Complete remission was defined as a reduction of proteinuria to <0, 5g/24h, inactive urinary sediment and serum creatinine <115% of baseline; partial remission same parameters, except proteinuria <1g/24h if initial value <3h/24h, or reduction to <3g/24h if initial value >3g/24h. The studied predictors were the INS/RPS LN classification and the morphological indexes described by Austin (Activity and Chronicity) and Hill, obtained after histomorphological review of renal biopsies. Statistical analysis was performed with STATA software. Results: During 6 years, there were 46 biopsy-proven LN cases, 84, 8% (n=39) woman, median 35 years old (27 – 42, 5) and 57, 6% (n=19) caucasian. 39 patients were already known to have SLE, 7, 44 (1, 13 – 12, 3) years previously. The median FUP was 31, 9 (13, 2 – 45, 6) months. Based on biopsy findings, 35 patients were started on immunosuppression – induction in 50% of cases with MMF and in 50% with cyclophosphamide; maintenance in 81% with MMF, the remaining with azathioprine. Complete remission was achieved in 58% of patients, 27% achieving partial remission. We observed 4 LN relapses. 96% (n=44) of the patients survived at the end of FUP, with a median serum creatinine of 0, 8 mg/dl (0, 7 – 0, 99), eGFR 99, 8 ml/min (71, 2 – 116, 8) and proteinuria of 0, 6 g/24h (0, 2 – 1, 6). We observed that Class IV patients had, at presentation, lower eGFR (67, 3 vs 94, 6 ml/min; p=0, 02), higher proteinuria (4, 26 vs 2, 37; p=0, 02) and a tendency towards higher C3 consumption (58, 9 vs 77, 4; p=0, 06). We did not observe correlations between ISN/RNP Classification and the outcomes at the end of FUP. The correlations between clinical findings and morphological indexes (Hill and Austin) are summarized in table 1 : Both the Hill biopsy index and the Chronicity index were correlated with renal function and proteinuria at the end of FUP. The Activity index correlated with the immunological findings – C3, C4 and anti-dsDNA. Conclusions: EULAR guidelines suggest that histomorphological evaluation in LN should go beyond ISN/RNP classification, and our data supports that – we observed a correlation between the renal outcomes and the indexes described by Austin and Hill. Disclosure of Interest: None declared