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Abstract: FR-PO604

Effect of Induction Therapy on Glomerular Morphometry in Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1304 Glomerular Diseases: Podocyte Biology

Author

  • Pichaiwong, Warangkana, Rajavithi Hospital, Bangkok, Bangkok, Thailand
Background

Based on a series of randomized controlled trials (RCTs), the data have demonstrated an efficacy treatment response defined by clinical outcomes between intravenous cyclophosphamide (IVCYC) and mycophenolate mofetil (MMF) for induction therapy of lupus nephritis (LN). Only few studies have systematically examined glomerular morphometric responses to induction therapy. This study was aimed to assess the effect of induction therapy in the aspect of glomerular morphometry.

Methods

We have analyzed renal biopsies obtained from 20 patients with proliferative and membranous LN patients who underwent protocol renal biopsies after induction therapy. The glomerular morphometry was demonstrated by percentage of mesangial matrix expansion which was quantitated by silver methenamine and podocyte density was counted.

Results

Of the 20 patients included, the mean age was 32.20±13.19 years, 85% was female. The mean arterial blood pressure was 160.11±7.15 mm.Hg. The mean baseline estimation for glomerular filtration rate was 83.11±35.03 ml/min/1.73m2 and the median urine albumin to creatinine ratio was was 2.22 (1.60-3.93). The Median range of C3 concentration was 0.65 (0.54-0.85) g/L. The mean of total numbers of glomeruli obtained was 25.07±8.86 glomeruli/biopsy, disease activity and chronicity indices were 5.8/24 and 2.3/12, respectively.

After completion of the induction therapy, glomerular tuft area occupied by silver-stained matrix was decreased (pre-induction 8.60±1.77% vs. post-induction 5.91±2.23%, p=0.954). There was an exhibited increase in podocyte number (pre-induction 238.64±117.33 vs. post-induction 268.00±121.52, p=0.388), podocyte density (pre-induction 74.45±25.87/x106 um3 vs. post-induction 88.25±23.43/x106 um3, p=0.590) and decreased glomerular volume/podocyte (pre-induction 15,386.73±6,572.53 um3 vs. post-induction 12,119.50±4,020.53 um3, p=0.575).

Conclusion

This study shows that there is a trend to improve glomerular morphometry particularly podocyte density following induction therapy with either IVCYC or MMF in patients with biopsy-proven proliferative LN. However, more sample sizes are needed to adequately assess these outcomes.

Funding

  • Government Support – Non-U.S.