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Kidney Week

Abstract: PO1602

Role of Kidney Biopsies in Systemic Lupus Erythematosus Patients: Clinicopathologic Correlation

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Leuprecht, Lorenz, Weill Cornell Medicine, New York, New York, United States
  • Chevalier, James M., Weill Cornell Medicine, New York, New York, United States
  • Muthukumar, Thangamani, Weill Cornell Medicine, New York, New York, United States
  • Seshan, Surya V., Weill Cornell Medicine, New York, New York, United States
Background

Lupus nephritis (LN) affects >50% of the patients with systemic lupus erythematosus (SLE) and is a major cause for morbidity and mortality. The diagnosis of LN as well as the extent and severity of renal involvement are assessed via kidney biopsy. However, appropriate clinical indications for a kidney biopsy are not well defined in adults, nor is the predictability of the clinical presentation. Therefore, a clinicopathologic correlation of patients with SLE and presumed SLE who underwent a kidney biopsy is conducted.

Methods

We evaluated a total of 134 biopsy samples from 123 patients with either SLE or presumed SLE at the time of biopsy that were obtained during a 10-year period at a large medical center in New York City. 11 patients underwent a biopsy twice during that period. Laboratory, and clinical data were also collected retrospectively via chart review.

Results

86% of the patients were female, 31% African American, 21% White, and 11% Asian. The mean age at the time of the biopsy was 36.2±12.6 years, the mean serum-creatinine 1.45±1.28 mg/dl, and the mean urinary protein excretion 3.86±3.43 g/d. 97% of the biopsy samples had evidence of LN, with the majority showing either Class IV+V (29%) or Class V (33%). About 13% had findings other than LN, such as TMA, focal collapsing features of the glomeruli, diabetic nephropathy, or possible ANCA vasculitis, with or without evidence of LN. Additionally, in patients of 65% of the biopsy samples, eGFR was ≥60 ml/min/1.73 m2, and 29% (38/132) had a negative urine dipstick for blood. Complement levels were low in 88/128 instances, and anti-dsDNA was positive in 57% of the instances (n=127). When comparing all proliferative forms of LN (n=74) with Class V alone (n=44), patients with a proliferative form were younger, had a higher creatinine, higher proportion of hematuria, anti-dsDNA positivity, low complements, as well as a proteinuria level ≥1 g/d.

Conclusion

We conclude that normal serum-creatinine values may not preclude significant kidney pathology in SLE patients and those with proliferative forms of LN may have a negative urine dipstick for blood (16%), normal complement levels (14%), and/or a negative anti-dsDNA test (29%) around the time of the biopsy. Furthermore, patients with SLE may have other morphologic findings correlating with clinical renal presentation, instead of LN.