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.
Clinical Outcomes In SLE Patients Since the introduction of the 2003 ISN/RPS Classification of Lupus Nephritis.
Jordan, Natasha, Sangle, Shirish, Karim, Yousuf, Tungekar, Fahim, Abbs, Ian, D'Cruz, David P.
Lupus nephritis affects approximately 60% of Systemic Lupus Erythematosus (SLE) patients and is associated with significant morbidity and mortality. The 2003 International Society of Nephrology (ISN)/Renal Pathology Society (RPS) classification is currently used to histologically define lupus nephritis classes.
The objectives of this research were to determine the rate of progression to end-stage renal disease in lupus nephritis patients who have undergone renal biopsy since the introduction of the 2003 ISN/RPS classification and to identify risk factors associated with poor outcome.
We retrospectively reviewed the clinical data of 84 lupus nephritis patients who underwent renal biopsy since the introduction of 2003 ISN/RPS classification. Data collected included demographic details, autoantibody profiles, co-existence of Antiphospholipid Syndrome, activity and chronicity indices on renal biopsy and renal outcomes.
99 renal biopsies were performed in 84 SLE patients since the introduction of 2003 ISN/RPS classification. 83% of those biopsied were female (n=70) and 17% were male (n=14). The mean age at renal biopsy in female patients was 35 years (range 1064 years) and 26 years in male patients (range 1450 years). 41.6% of patients biopsied were of Caucasian origin (n=35), 32% were of Afro-Caribbean descent (n=27) and 21.4% of Asian extraction (n=18). 7% of our cohort progressed to advanced renal impairment requiring dialysis or renal transplantation.
Afro-Caribbean ancestry was associated with an increased likelihood of developing advanced renal disease (p=0.053). Younger age at renal biopsy was also associated with a worse outcome. Patients with class IV-G on biopsy were more likely to develop renal impairment (p=0.049). No particular autoantibody profile was associated with an adverse outcome. The presence of anti-cardiolipin antibodies, lupus anticoagulant or thrombotic microangiopathy on biopsy were not associated with disease progression in this cohort. High chronicity index on renal biopsy was significantly associated progression to end-stage renal impairment (p=0.001). High activity index on renal biopsy was not associated with the development of renal failure.
Figure 1. Frequency of lupus nephritis classes seen on renal biopsy
Figure 2. Clinical outcomes in ISN/RPS lupus nephritis classes based on KDOQI (kidney disease outcomes quality initiative) stages of kidney disease. GFR (glomerular filtration rate)
Despite advances in the clinical management of lupus nephritis with earlier recognition of disease and improved immunosuppressive regimens, a proportion of patients still progress to end-stage renal failure. In our cohort 7% of patients progressed to advanced renal disease. In our cohort patients with proliferative nephritis were more likely to require renal replacement therapy particularly those with class IV-G nephritis. The association with high chronicity indices on biopsy and progression to renal impairment emphasizes the importance of prompt diagnosis and initiation of appropriate therapy.
To cite this abstract, please use the following information:
Jordan, Natasha, Sangle, Shirish, Karim, Yousuf, Tungekar, Fahim, Abbs, Ian, D'Cruz, David P.; Clinical Outcomes In SLE Patients Since the introduction of the 2003 ISN/RPS Classification of Lupus Nephritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :631