Abstract: SA-PO248

Clinical Parameters after Induction Treatment Are Better Predictors of 36-Month Renal Survival Than the Baseline Biopsy Histopathological Scores in Lupus Nephritis

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Rodriguez, Sonia, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  • Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
  • Uribe-uribe, Norma O., Instituto Nacional de Ciencias Medicas y Nutricion, "Salvador Zubiran", Mexico City, Mexico
  • Mejia-Vilet, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
Background

Baseline clinical parameters and histopathological scores have been associated with lupus nephritis (LN) outcomes. Recently, it was suggested that adding intimal hyperplasia findings to the NIH chronicity score (CS) may enhance its predictive value. We evaluated the capacity of before and after-treatment clinical and histopathological parameters to predict 36-month renal survival.

Methods

We included a cohort of 255 patients with class III, IV or V LN and a minimum 36-month follow-up. We registered clinical and histopathological parameters and determined their predictive value for 36-month renal survival by means of logistic regression and ROC curves. A new chronicity score (CS+vasc) was created by adding 0 or 1 point to the NIH chronicity score based on vascular intimal thickening findings .

Results

The cohort comprised 89% female patients, median age 28 years (IQR 23-37). Median baseline eGFR and proteinuria were 81ml/min (IQR 45-117) and 3.2g/g (IQR 1.9-5.3) respectively. Forty patients (15.7%) developed end-stage renal disease by 36 months. The ROC curves area under the curve were 0.732 for baseline eGFR, 0.602 for baseline proteinuria, 0.620 for the NIH activity score, 0.739 for the chronicity score, 0.760 for CS+vasc 0.760, 0.857 for 12-month eGFR , 0.835 for 12-month proteinuria (figure). A 12-month proteinuria <0.8 had 71% sensitivity and 88% specificity for 36-month survival (LR 5.70) The activity score was associated with lower renal survival exclusively at a cutoff over 10 points.

Conclusion

Post-treatment 12-month proteinuria is an individual good renal survival predictor. At baseline, the best predictor is the histopathological NIH CS, which improves little with the addition of points for intimal thickening evaluation.