Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Association of Lupus Nephritis Class with Poor Longterm Outcomes.
Petri, Michelle, Fang, Hong
Background/Purpose:
Lupus nephritis is a common manifestation of SLE. We investigated the association between renal biopsies by the International Society of Nephrology (ISN) class in SLE and poor renal outcome, defined not just by renal failure, but also by nephrotic syndrome and thrombosis.
Methods:
503 SLE patients (39.4% Caucasian, 49.5% African-American, 89.5% female, mean age of diagnosis 28.8 ± 12.0) with biopsy-proven lupus nephritis (LN) were selected as the study population in a longitudinal cohort study. The renal biopsies were classified according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) as class I (minimal mesangial lupus nephritis), class II (mesangial proliferative lupus nephritis), class III (focal lupus nephritis), class IV (diffuse lupus nephritis), class V (membranous lupus nephritis) and class VI (advanced sclerosing lupus nephritis).
Results:
Table. Association of outcome with renal biopsy
| Class of renal biopsy | All | Caucasian | African-American | % Nephrotic Syndrome | % Renal failure | % Any thrombosis |
|---|---|---|---|---|---|---|
| II | 44 (8.8%) | 17 (38.6%) | 27 (61.4%) | 20 (45.5%) | 9 (20.5%) | 14 (31.8%) |
| III | 80 (15.9%) | 35 (43.8%) | 35 (43.8%) | 32 (40.5%) | 10 (12.5%) | 19 (23.8%) |
| IV | 166 (33.0%) | 69 (41.6%) | 68 (41.0%) | 99 (60.4%) | 58 (34.9%) | 53 (31.9%) |
| V | 97 (19.3%) | 35 (36.1%) | 57 (58.8%) | 56 (58.3%) | 8 (8.3%) | 31 (32.0%) |
| II,III | 8 (2.0%) | 3 (37.5%) | 4 (50.0%) | 5 (62.5%) | 2 (25.0%) | 5 (62.5%) |
| II,III,V | 4 (0.8%) | 2 (50.0%) | 2 (50.0%) | 4 (100%) | 1 (25.0%) | 1 (25.0%) |
| II,IV | 10 (2.0%) | 5 (50.0%) | 5 (50.0%) | 4 (40.0%) | 2 (20.0%) | 4 (40.0%) |
| II,IV,V | 4 (0.8%) | 1 (25.0%) | 2 (50.0%) | 4 (100%) | 0 (0%) | 1 (25.0%) |
| II,V | 12 (2.4%) | 7 (58.3%) | 5 (41.7%) | 9 (75.0%) | 2 (16.7%) | 6 (50.0%) |
| III,V | 42 (8.4%) | 13 (31.0%) | 23 (54.8%) | 24 (58.5%) | 6 (14.3%) | 11 (26.2%) |
| IV,V | 36 (7.2%) | 11 (30.6%) | 21 (58.3%) | 25 (73.5%) | 17 (47.2%) | 13 (36.1%) |
503 patients were classified into 11 different groups based on the findings of the first biopsy. African-Americans were more likely to have Class V (P=0.044).
Conclusion:
In lupus nephritis, the most common class was class IV. Class IV either as the sole class or as a mixed class had the greatest risk of renal failure. However, nephrotic syndrome and thrombosis were common regardless of ISN class. Reliance on renal failure as the only outcome would miss these other important longterm consequences of lupus nephritis.
To cite this abstract, please use the following information:
Petri, Michelle, Fang, Hong; Association of Lupus Nephritis Class with Poor Longterm Outcomes. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :622
DOI:
