Kidney Week

Abstract: FR-PO1101

Chronic Changes in Lupus Nephritis Biopsies – When to Treat? Could Complement C3c Be an Indicator for Missed Activity?

Session Information

• Glomerular Diseases: Clinical, Outcomes, Trials - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Wilson, Hannah R., Imperial College London, Hammersmith Hospital, London, United Kingdom

Hannah R. Wilson,

• Turner-Stokes, Tabitha, Imperial College London, Hammersmith Hospital, London, United Kingdom

Tabitha Turner-Stokes,

• Dasilva Santos, Iara, Imperial College London, Hammersmith Hospital, London, United Kingdom

Iara Dasilva Santos,

• Griffith, Megan, Imperial College London, Hammersmith Hospital, London, United Kingdom

Megan Griffith,

• Levy, Jeremy B., Imperial College London, Hammersmith Hospital, London, United Kingdom

Jeremy B. Levy,

• Cairns, Tom, Imperial College London, Hammersmith Hospital, London, United Kingdom

Tom Cairns,

• Cook, H. Terence, Imperial College London, Hammersmith Hospital, London, United Kingdom

H. Terence Cook,

• Lightstone, Liz, Imperial College London, Hammersmith Hospital, London, United Kingdom

Liz Lightstone,

Background

Management of biopsies showing chronic disease only is a common clinical conundrum in lupus nephritis (LN), especially when the biopsy is performed due to clinical features indicating activity. We have recently demonstrated that complement C3c staining is an indicator of current activity of the complement pathway in LN. We analysed characteristics that prompted treatment of patients with biopsies showing LN class III/IV(C) only from our LN cohort & reviewed whether positive C3c staining is a surrogate for disease activity.

Methods

Demographic, clinical, histopathological & outcome data were reviewed for renal biopsies showing III/IV(C) LN between 1/1/1996 & 1/1/2016. Treated patients were compared with untreated patients. C3c positive & C3c negative biopsies were then compared.

Results

129 biopsies were performed over the 20 years which showed III/IV(C) disease only. 53% of these patients had escalation of their treatment post biopsy.

31 of the patients with a “chronic” biopsy had a subsequent biopsy available for review.

Conclusion

Deciding to treat patients with only chronic changes on biopsy was significantly associated with indication for biopsy, positive C3c staining, presence of subendothelial deposits & eGFR at the time of biopsy. However, our analysis thus far does not show a benefit of treating these patients as uPCR is actually higher in treated patients at 1 year although improved from baseline & eGFR, better at baseline in the treated group, actually falls. The repeat biopsies may suggest that not treating those with C3 positivity may lead to progressive scarring.