ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1925

The ISN/RPS 2016 Classification Predicts Renal Prognosis in Patients with First-Onset Class III/IV Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Hachiya, Asaka, Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
  • Karasawa, Munetoshi, Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
  • Imaizumi, Takahiro, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan
  • Kato, Noritoshi, Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
  • Katsuno, Takayuki, Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
  • Ishimoto, Takuji, Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
  • Kosugi, Tomoki, Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
  • Tsuboi, Naotake, Department of Nephrology, Fujita Health University Graduate School of Medicine, Toyoake, Aichi, Japan
  • Maruyama, Shoichi, Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Background

Lupus nephritis (LN) is a life-threatening complication of systemic lupus erythematosus. The 2003 pathological classification of LN by the International Society of Nephrology/Renal Pathology Society (ISN/RPS) was revised in 2016; it quantitatively evaluates the interstitium in addition to the glomeruli. To date, the clinical utility of the 2016 classification has not been fully investigated.

Methods

We performed a retrospective multicenter cohort study and investigated the utility of the 2016 classification—including the activity index (AI), chronicity index (CI), and each pathological component to predict CR or renal function decline defined as 1.5-fold increase in serum creatinine levels (sCr)—and compare with that of the 2003 classification. Adult patients with first-onset class III/IV LN who were newly prescribed any immunosuppressants were consecutively enrolled from January 2004 to December 2014 and observed until July 2016.

Results

We enrolled 91 patients (number of female, 65; median age [interquartile rage: IQR], 47 [30–62] years old; median estimated glomerular filtration rate (eGFR), 64 [IQR: 45–84] ml/min/1.73 m2; median proteinuria, 1.9 [IQR: 0.9–4.6] g/gCr). During the observation period (median, 51 [IQR: 23–77] months), 35 patients achieved CR, and 16 developed 1.5-fold increase in sCr. The A or A/C subclasses based on the 2003 classification were not associated with clinical outcomes. After adjustments for eGFR and urinary protein levels, higher CI and interstitial inflammation scores were associated with failure to achieve CR (adjusted hazard ratios (HR) [95% confident interval (CI)]: 0.75 [0.64–0.88], 0.39 [0.25–0.61], respectively). Similarly, higher CI and higher interstitial fibrosis and lower hyaline deposit scores were associated with renal functional decline (adjusted HR [95%CI]: 1.24 [1.01–1.53], 2.66 [1.43–4.93], 0.45 [0.21–0.97], respectively).

Conclusion

We demonstrated the utility of CI and importance of assessing interstitial regions in predicting renal prognosis. The 2016 classification can predict the clinical outcomes more precisely than the 2003 classification.

Funding

  • Commercial Support