Kidney Week

Abstract: FR-PO883

Wire-Loop Lesion Is Associated with Serological Immune Abnormality but Not Renal Prognosis in Lupus Nephritis

Session Information

• Glomerular Diseases: Membranous Nephropathy, SLE, Complement
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Zoshima, Takeshi, Kanazawa university hospital, Kanazawa, Japan

Takeshi Zoshima,

• Hara, Satoshi, Kanazawa Graduate School of Medicine, Kanazawa, Ishikawa, Japan

Satoshi Hara,

• Kawano, Mitsuhiro, Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan

Mitsuhiro Kawano,

Background

Revised ISN/RPS 2018 Classification of Lupus Nephritis (LN) includes wire-loop lesion (WL) as one of the activity indexes (AI). LN patients with WL are classified as class III or IV, both of which are associated with a poor prognosis and recommended to be treated by intense immunosuppressive therapy. However, few reports have focused on the clinicopathological impact of WL on serological immune abnormality and renal prognosis. We aimed to identify clinicopathological characteristics associated with WL, and to clarify whether WL predicts renal prognosis of LN.

Methods

We enrolled 126 Japanese LN patients subjected to renal biopsy in 11 hospitals from 2000 to 2018. We measured clinical findings at the time of renal biopsy, and determined the presence of comorbidities. We also measured Cr and eGFR at the last patient visit, and recorded medications prescribed for LN. Glomerular and tubulointerstitial lesions were expressed as the rate involved of all observed glomeruli or cortex, respectively. Chronic kidney disease (CKD) was defined as eGFR <60 ml/min/1.73m². In class III or IV patients, we retrospectively compared these clinicopathological findings between those with WL (WL+ group) and without WL (WL- group).

Results

Of 126 patients, 100 (79.4%) were classified as class III or IV (78 females; mean age 42.7 years; observational period 59.6 months). WL was found in 36 of them (36.0%). Although the renal function did not differ (eGFR; 83.1±33.7 vs 78.0±33.2 ml/min/1.73m², p=0.56), WL+ group had higher titer of serum anti-dsDNA Abs (median values; 184 vs 50 IU/ml, p=0.026) and lower level of C3 (42.6±19.4 vs 51.7±24.7 mg/dl, p=0.06) than WL- group. There were no significant differences in any other clinical findings. Linear regression analysis revealed associations between anti-dsDNA Abs and WL (β=0.36, p=0.01). There was no difference in the latest eGFR (78.1±24.5 vs 74.9±27.1 ml/min/1.73m², p=0.62) between the two groups. Cox regression analysis revealed significant associations of CKD at the last visit with age and hypertension, but not with WL.

Conclusion

WL was associated with serum anti-dsDNA Abs, but not with renal prognosis, suggesting that WL reflects immune abnormality, but is not an independent factor predictive of renal prognosis in LN.