FRI0164 BANFF INFLAMMATORY INDICES MAY BE SUPERIOR TO THE NIH SCORING IN PREDICTING CKD PROGRESSION IN LUPUS NEPHRITIS. (2nd June 2020)

• Record Type: Journal Article
• Authors: Duong, M. D.; Schwartz, D.; Wang, S.; Broder, A. R.; Goilav, B.
• Is Part Of: Annals of the rheumatic diseases. Volume 79(2020)Supplement 1
• Page Start: 665
• Page End: 666
• Publication Date: 2020-06-02
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2020-eular.1534
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Chronic kidney disease/end stage renal disease (CKD/ESRD) from lupus nephritis (LN) is a major cause of morbidity and mortality. Advanced tubulointerstitial disease (TID) in LN is a better predicor of renal outcome than glomerular lesions. The current NIH classification is heavily weighted towards glomerular lesions and only provides a semiqualitative assessment of TID. In contrast, Banff classification of renal allograft pathology provides 6 reproducible scores for TID (inflammation, fibrosis, atrophy). Banff scoring may better predict CKD/ESRD in LN than NIH scores Objectives: We compared Banff grading vs. NIH scoring as predictors of CKD progression at 5 years, defined as a decline in estimated glomerular filtration rate (eGFR) ≥30%, a strong risk factor for ESRD and mortality Methods: We included patients with LN class III, IV, V on the index biopsy Jan 2005 and Dec 2018. H&E/PAS stained slides were reviewed and scored by an experienced pathologist. Six TID Banff scores (0/1 vs. 2/3), NIH activity/chronicity (AI/CI) and NIH interstitial fibrosis/tubular atrophy (IF/TA), tubulointerstitial inflammation (TII) scores (none/mild vs. moderate/severe) were evaluated as predictors of CKD progression using survival analyses Results: Of the 125 patients, 46 had CKD progression and 20 subsequently developed ESRD. There were no differences between progressors and non-progressors in terms of baseline demographic, clinical data, LN class (Tab 1). Banff ti score (total inflammation) was associated with CKD progression in bivariate and time-dependent analyses. However, NIH TII score and corresponding Banff i score were not predictive (Tab 2, Fig 1 ). Overall NIH AI and CI were not predictive of CKD progression. Moderate/severe NIH IF/TA was associated with CKD progression as was Banff ci (interstitial fibrosis) score (Tab 2, Fig 2 ). Banff score for atrophy was not predictive. In a subset of 92 patients with baseline eGFR≥60ml/min/1.73m 2 only Banff ti score (but not i score or NIH TII, IF/TA) was predictive of CKD progression (Fig 1 ) Conclusion: Banff inflammation scores may be superior predictors of CKD/ESRD progression at 5 years, compared to the currently used NIH classification. Detection of inflammation by Banff scores may allow earlier interventions to prevent ESRD Disclosure of Interests: None declared