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Kidney Week

Abstract: FR-PO1098

The Clinical Indicators to Predict Active Lesion in Kidney Biopsy Specimen in Patients with Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ichikawa, Daisuke, St Marianna University of Medical School, Yokohama City, Kanagawa, Japan
  • Okada, Eri, St. Marianna University School of Medicine, Kawasaki, Japan
  • Suzuki, Tomo, St Marianna University of Medical School, Yokohama City, Kanagawa, Japan
  • Watanabe, Shiika, St Marianna University of Medical School, Yokohama City, Kanagawa, Japan
  • Koike, Junki, the Kawasaki Municipal Tama Hospital, Kawasaki Citiy Tama Ward, Japan
  • Shibagaki, Yugo, St Marianna University Hospital, Kawasaki, Japan
Background

The histological activity of International Society of Nephrology/Renal Pathology Society (ISN/RPS) class IIIa or IVa lupus nephritis affect physician’s decision making in treatment. Because renal biopsy has inevitable risk for bleeding, it is preferable that we can make decision only with clinical parameters. However, few studies have addressed this important issue so far.

Methods

We reviewed the renal biopsy specimen of 120 patients with SLE retrospectively. We analyzed whether and which laboratory findings are correlated with histological activity.

Results

The histologically active lesion of lupus nephritis was found in 73.3% of all the patients, in 50% of the patients with the group of no hematuria, and in 70.8% of the patients with intermittent hematuria. Hematuria significantly correlated with histological activity with a sensitivity of 86.4% and a specificity of 37.5%, and significant proteinuria [≧0.5 g/gram creatinine (gCr)] significantly correlated with histological activity with a sensitivity of 84.1% and a specificity of 34.4%. If combining hematuria and proteinuria, the sensitivity for histological active lesion increased to 96.6%. Low serum C3 (< 65 mg/dl) significantly correlated with renal disease activity with a sensitivity of 79.1%, and high serum anti-DNA antibody (≧10 IU/ml) significantly correlated with histological activity with a sensitivity of 91.4%. Existence of at least one of these clinical indicators (hematuria, proteinuria, high anti-DNA antibody and low C3) showed 100% sensitivity for histological activity. Those with high specificity were persistent hematuria (specificity 71.5%), anti-DNA antibody≧40 IU / ml (specificity 73.1%), and existence of all 4 of the clinical indicators (specificity 81.3%).

Conclusion

Isolated or intermittent hematuria did not predict histological activity so well. In order to avoid overlooking active lupus nephritis without kidney biopsy, we should count not only hematuria but also significant proteinuria, low C3 and high anti-DNA antibody. If the renal biopsy is not possible, but we still suspect activity such as in cases with progressive decline in kidney function, persistent hematuria, anti-DNA antibody≧40 IU/ml and presence of all 4 of clinical indicators strongly suggest disease activity and may help us make decision for active treatment.