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Abstract: FR-PO1096

Lupus Nephritis IV-S versus IV-G: Different Characteristics and Renal Outcomes

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Oliveira, Camila Barbosa lyra, Hospital das Clinicas - UFPE, Recife(PE) BRAZIL, Brazil
  • Vajgel, Gisele, Hospital das Clinicas - UFPE, Recife(PE) BRAZIL, Brazil
  • Costa, Denise Maria do Nascimento, Hospital das Clinicas - UFPE, Recife(PE) BRAZIL, Brazil
  • Cavalcante, Maria Alina G.M., Hospital das Clinicas - UFPE, Recife(PE) BRAZIL, Brazil
  • Valente, Lucila Maria, Hospital das Clinicas - UFPE, Recife(PE) BRAZIL, Brazil
Background

The ISN/RPS classification of lupus nephritis (LN) divided class IV into segmental and global (IV-S and IV-G), based on evidence suggesting different characteristics and renal outcomes. However, others subsequent studies failed to detect these differences. The aim of this study was to compare characteristics and renal outcomes of classes IV-S and IV-G.

Methods

Retrospective cohort of adult patients with lupus and biopsy proven class IV according to ISN/RPS classification. Clinicopathological characteristics and long-term follow-up were analyzed. Primary end point was ESRD.

Results

Clinicopathological data and renal outcomes of 89 patients with LN class IV are shown in Table 1. There was no difference in tubular atrophy and interstitial fibrosis between classes. Compared to patients with class IV-S, patients with class IV-G had a risk 2.8 times greater of doubling sCr (95%CI 1.4-6.7; p=0.001) and 3.9 times greater of ESRD (95%CI 1.4-5.6; p=0.006).

Conclusion

Patients with class IV-G had more severe clinicopathological presentation and worse renal outcomes compared to patients with class IV-S.

Baseline clinicopathological characteristics and renal outcomes of 89 patients with lupus nephritis class IV
CharacteristicsIV-S
N=34
IV-G
N=55
p-value
Age, median (min-max) (years)27.5 (18-51)33.0 (18-57)0.114*
Female, %97.194.51.000¥
Race (non-white), %55.970.90.148‡
Hypertension (BP≥140x90mmHg), %64.788.90.006‡
Rapidly progressive glomerulonephritis, %29.460.0<0.001‡
Serum creatinine (mg/dl)1.2 (0.9-2.5)2.0 (0.9-3.4)0.085§
Creatinine Clearance, ml/min/1.73m256.0 (25.6-79.3)30.9 (15.8-79.2)0.085§
Proteinuria, g/24h3.5 (2.2-4.8)3.9 (2.2-7.0)0.346§
Induction Treatment, %
Cyclophosphamide
Mycophenolate Mofetil

76.5
23.5

83.6
16.4
0.403‡
Pathological characteristics
Number of glomeruli, median (min-max)
Fibrinoid necrosis, %
Wire-loops, %
% glomeruli with crescent
50% of glomeruli with crescents, %

16.5 (10-29)
2.9
23.5
0 (0-19)
5.8

14.0 (10-38)
5.5
34.5
26 (0-50)
34.5

0.215§
1.000¥
0.272‡
0,001§
0.002‡
Follow-up (months)
Complete remission, %
Partial remission, %
Renal flare, %
Final serum creatinine (mg/dl)
Final creatinine clearance, ml/min/1.73m2
Doubling serum creatinine, %
End stage renal disease, %
62.5 ± 34.2
20 (58.8)
10 (29.4)
8 (23.5)
0.9 (0.7-1.3)
79.7 ± 37.5
7 (20.6)
3 (8.8)
54.0 ± 39.5
18 (32.7)
17 (30.9)
15 (27.3)
1.6 (0.8-4.1)
56.0 ± 41.9
32 (58.2)
19 (34.5)
0.299*
0.016‡
0.887‡
0.695‡
0.010§
0.009*
0.001‡
0.006‡

Values expressed as median with range (25th – 75th percentile); Creatinine Clearance was calculated by CKD-EPI equation; * T-test; ¥ Fisher’s exact test; ‡ Chi-squared test; § Mann-Whitney test.