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Abstract: TH-PO627

The Impact of Late Renal Biopsy on Renal Survival in Patients with Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Nunes, Mariana, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Jorge, Lectícia, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Yu, Luis, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Woronik, Viktoria, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Dias, Cristiane B., Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
Background

Brazil is the American country with the highest African ancestry. In lupus nephritis (LN) it is possible to observe differences in incidence and even severity according to the location and characteristics of the population studied. This study aims to describe the clinical-epidemiological profile and the influence of late diagnosis in patients with LN at the Nephrology Service of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, between the period from 1999 to 2015.

Methods

Retrospective descriptive observational study of patients diagnosed with LN and biopsied before six months of the onset of LN symptoms compared to those biopsied after six months or more than of the onset of symptoms.

Results

The total sample size was 398 patients. FAN was positive in 94.1% of patients, anti-DNA in 77.7% and anticardiolipin in 27.1%. The full-house pattern was observed in 124 patients (33.7%). Considering the time from the onset of LN-related symptoms until the kidney biopsy, in 47.5% this time was less than 6 months (early group) and in 52.5% this time was greater than or equal to 6 months (late group). The chronicity index was lower in the group biopsied less than 6 months, 2(1-4) vs 3(2-5), p= 0.003, with a higher activity index in this same group (5 (3-8) vs 4 (3-6), p= 0.006). The chronicity index had a positive correlation with initial, 3-month, 6-month and 5-year creatinine after renal biopsy, with r=0.56 and p< 0.0001, r=0.51 and p<0.0001, r=0.51 and p<0.0001 and r=0.38 and p<0.0001, respectively. Fifty-three patients progressed on dialysis over five years of follow-up and in uni and multivariate analysis late renal biopsy and chronicity index starting at 4 were independent factors for this worse outcome.

Conclusion

This study showed that renal outcomes in renal replacement therapy or chronic kidney disease were associated with delayed renal biopsy and higher chronicity index at diagnosis. Late biopsy comes from a delay in referral to a tertiary hospital nephrologist and therefore a delay in diagnosis and initiation of appropriate treatment for that patient.