Abstract: PO1601
Serological Activity in Pure Membranous Lupus Nephritis in a Predominantly Black Population
Session Information
- Glomerular Diseases: Clinicopathological Features and Outcomes in IgAN, Lupus Nephritis, and Vasculitis
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Roberts, Levard G., Emory University, Atlanta, Georgia, United States
- Arora, Aakriti, Emory University, Atlanta, Georgia, United States
- Mozee, Hilton, Emory University, Atlanta, Georgia, United States
- Cobb, Jason, Emory University, Atlanta, Georgia, United States
Background
Clinically significant kidney disease is estimated to occur in nearly 60% of patients with systemic lupus erythematosus (SLE). A majority of these patients develop proliferative disease, however 10-15% develop a non-proliferative form of disease known as membranous lupus nephritis (LN) (Class V lupus nephritis). These patients typically present with significant proteinuria. Austin et al. reported 7% of patients with low complements levels and 21% with elevated anti-dsDNA levels. In this study we assess serological activity (C3, C4, anti-dsDNA) of pure membranous LN in a predominantly black patient population
Methods
Kidney biopsy log from 2010 – 2017, and a retrospective chart review was completed. We excluded any patients with proliferative disease (active or chronic). We analyzed serological activity (C3 level, C4 level & anti-dsDNA) at time of renal biopsy and again at 24 weeks.
Results
Of the total 101 patients with pure membranous LN, we had 54 patients with sufficient follow-up data. 52 of the 54 patients were female with an average age of 35.5; 92.5% (50 of 54) were black. At time of kidney biopsy, low C3 and low C4 was found in 54% and 41% of patients respectively. Whereas an elevated anti-dsDNA was identified in 39% with 20% having the classic triad of low C3, low C4 and elevated anti-dsDNA. When compared to 24 weeks (roughly end of induction therapy) low C3 and low C4 was found in 37% and 24% of patients respectively. Whereas an elevated anti-dsDNA was identified in 31% with 13% have the combination of low C3, low C4 and elevated anti-dsDNA
Conclusion
In this predominantly black population of pure membranous LN the majority of patients did not have the classic triad of low complements and elevated dsDNA (20% at time of diagnosis/biopsy). Compared to others looking at pure membranous we did find higher rates of low complements and elevated anti-dsDNA at time of diagnosis (54% with low C3 initially). Possibly due to our unique urban patient population which is >90 percent black; i.e. more severe SLE. Despite the majority of patients not having the classic triad of low C3, low C4, and elevated anti-dsDNA, clinical providers must be diligent in assessing the need for kidney biopsy in SLE and non-SLE patients as serological activity does not correlate with biopsy findings. Earlier treatment correlates with improved prognosis.