Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Renal Biopsy in Systemic Lupus Erithematosus Patients with Low Levels of Proteinuria.

Rodriguez,  Esther, Sanchez,  Julio, Salgado,  Eva, Mateo,  Isabel, Galindo,  María, E. Carreira,  Patricia

Objective:

To evaluate the need of performing renal biopsy in SLE patients with low levels of proteinuria.

Patients and Methods:

From 443 patients included in our SLE data base (1974–2009), 150 with biopsy proven lupus nephritis were selected. Demographic (sex, age at onset and diagnosis, death), clinical (type of nephritis, proteinuria, urinary casts, creatinine, aDNA, complement, high blood pressure –HBP-), treatment and outcome (renal failure, relapse, death) data, had been previously included in the data base, or were obtained from the charts. In patients with proteinuria <1 g/d, relationship between clinical data and renal histology, and risk factors for relapse and renal failure were analyzed. Clinical and outcome data were compared between patients with proteinuria lower and higher than 1 g/d. Chi square, Student t test and binary logistic regression were used for statistics.

Results:

Out of 150 patients, 42 (29%; 39 f, 3 m; age 30±14 a) had proteinuria <1g/d. Ten patients (24%) did not have renal symptoms, 15 (37%) presented HBP, 8 (19%, all with HBP) creatinine elevation, 9 (21%) granular casts, 26 (62%) aDNA and 36 (86%) low complement levels. Renal biopsies showed: minimal changes 1 (2%), mesangial GN 18 (43%), focal proliferative GN 7 (17%), diffuse proliferative GN 12 (29%) and membranous GN 4 (9%). No correlation between clinical characteristics and histological findings were found. One patient did not receive any treatment, 19 received only glucocorticoids, 15 cyclophosphamide, 6 azathioprine and 1 mophetil mycophenolate. Thirty seven (97%) responded well to therapy (28 complete and 9 partial response). After 14±8 years of follow up, 8 patients relapsed, 6 developed renal failure and 6 died. Presence of proliferative/membranous GN was a risk factor for relapse in this group (p<0.0001). Renal failure in patients with low levels of proteinuria was related to the presence of HBP (p<0.001) and creatinine elevation (p=0.006). Compared to 107 patients with higher proteinuria levels, these had more frequently diffuse proliferative GN (p=0.007) and more relapses (p=0.03). Both groups developed renal failure with similar frequency.

Conclusions:

More than half SLE patients with low proteinuria levels present severe disease on renal biopsy. Although they present less diffuse proliferative GN and renal relapses than patients with higher proteinuria, may develop renal failure with the same frequency. Our results support the convenience of performing renal biopsy and careful follow-up to patients with low proteinuria levels, especially if HBP and/or creatinine elevation are present.

To cite this abstract, please use the following information:
Rodriguez, Esther, Sanchez, Julio, Salgado, Eva, Mateo, Isabel, Galindo, María, E. Carreira, Patricia; Renal Biopsy in Systemic Lupus Erithematosus Patients with Low Levels of Proteinuria. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1171
DOI: 10.1002/art.28937

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