Abstract: FR-PO879
Venous Thromboembolism in Lupus Nephritis by ISN/RPS Biopsy Classification
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
- Cooley, Ian David, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Gibson, Keisha L., UNC Kidney Center, Chapel Hill, North Carolina, United States
- Derebail, Vimal K., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Alvarez, Carolina, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Poulton, Caroline J., UNC Kidney Center, Chapel Hill, North Carolina, United States
- Blazek, Lauren N., UNC Kidney Center, Chapel Hill, North Carolina, United States
- Love, Andrew, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Hogan, Susan L., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Jennette, J. Charles, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Falk, Ronald J., UNC Kidney Center, Chapel Hill, North Carolina, United States
- Sheikh, Saira Z., University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Background
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can be associated with venous thromboembolism (VTE). Lupus nephritis (LN) has been shown to be an independent risk factor for VTE. To our knowledge the risk of VTE has not been studied by International Society of Nephrology/Renal Pathology Society (ISN/RPS) LN class.
Methods
A cross-sectional analysis was performed using data from the Glomerular Disease Collaborative Network (GDCN). Patients with class V LN were compared to those with class III or IV (but not associated class V) LN. Classes I, II and VI were excluded from analysis due to their low prevalence. The outcome of interest was image-confirmed VTE. Logistic regression was used to calculate odds ratios and 95% confidence intervals (OR, 95% CI), adjusted for age, sex, race, hormonal contraception use, serum albumin and use of hydroxychloroquine. Effect modification was assessed between the main effect and other covariates and considered if p<0.05.
Results
Our cohort consisted of 533 patients; mean±SD age of 30.9±15.0 years (range 6-79 years), with an overall incidence of image-confirmed VTE of 54/533 (10.1%). In adjusted analyses, the odds of VTE were not significantly different for those with class III/IV compared to class V LN (OR, 95% CI: 1.00, 0.54-1.84). There was evidence of effect modification of LN class on VTE by age at biopsy. Among patients with an average age at biopsy of 15 (-1SD), class III/IV was associated with higher odds of VTE (5.38, 1.42-20.34) while among patients with an average age at biopsy of 45 (+1SD), class III/IV was associated with lower odds of VTE (0.26, 0.09-0.78).
Conclusion
VTE was common in LN patients in the GDCN, occurring in ~10%, and was similar among patients with class III/IV LN and those with class V LN. These findings suggest that the association between LN and VTE is not limited to class V-related nephrotic syndrome. Interestingly, however, age-specific analysis demonstrated increased odds of VTE with class III/IV LN diagnosed at a younger age and decreased odds of VTE with class III/IV LN diagnosed at an older age. This may suggest the presence of an age-sensitive modulation of LN class-specific VTE risk.