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.
Analysis of Risk Factors for Relapses and Chronic Renal Failure in Lupus Nephritis: Long Term Follow-up of Biopsy Proven 172 Patients Followed at a Single Center.
Artim-Esen1, Bahar, Ozluk2, Yasemin, Kilicaslan2, Isin, Omma1, Ahmet, Pehlivan1, Özlem, Inanc1, Murat
Istanbul University, Istanbul Faculty of Medicine,Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
Renal involvement is a major cause of mortality and morbidity in systemic lupus erythematosus (SLE) and carries a 1025 % risk of chronic renal failure (CRF). In this study, we aimed to analyse the characteristics and course of lupus nephritis (LN), determine the risk factors for flares and CRF.
An analysis of 172 patients with histopathologically proven LN registered and followed-up in our clinic (lupus clinic after 1993) between 1980 and 2010 was performed. Patients with adequate histopathologic and clinical data were selected for analysis. Biopsies were classified by both WHO and ISN/RPS 2003 systems by an experienced nephropathologist(IK). The association of clinical characteristics of the cohort with renal flares and outcome was investigated. Logistic regression analysis was done and Kaplan-Meier's method was used for survival analysis.
Eighty-one % of the cohort was female. Duration of renal disease was 103±66 and follow-up was 100±67 months. Class IV nephritis was the most frequent (55%) followed by class V (15%), class III (11%), class II (10,5 %) and combined(6,6%). Cyclophosphamide was used for remission induction in 80 %. Remission was achieved in 90 %. CRF developed in 25 patients (14,5 %), 4 of whom were transplanted and 8 stayed on permanent dialysis. There were 53 flares in 38 patients and the most common type was proteinuric (60,4%). Comparison of patients with and without a flare revealed that in non-relapsing patients, cyclophosphamide was more significantly used for remission induction (85 % vs 60%, p<0,001) and more patients were on mycophenolate mofetil (MMF) for maintenance (38 vs 12%, p=0,004). When active and chronic lesions at renal biopsies were compared, the presence of fibrous crescents was significantly prevalent in the relapsing group (17 vs 2%, p<0,001). At multivariate analysis not being on MMF at maintenance, fibrous crescents at biopsy, lack of exposure to cyclophosphamide at remission induction and anti-Sm positivity were found to be risk factors for flare. Of patients with a flare, 31,6% developed CRF (vs 6,6 % in non-relapsing group, p<0,001). Comparison of patients who developed CRF to others, revealed that presentation with acute renal failure (ARF), hypertension and increased creatinine, occurrence of a flare, fibrous crescents at biopsy were more frequent in CRF + group (60 vs 19 %, p <0,001; 28 vs 10 %, p=0,009, 47 vs 8 %, p<0,001; 33 vs 12 %, p=0,03; 30 vs 2 %, p<0,001 respectively). Significantly less number of patients were on MMF at maintenance in CRF + patients (16 % vs 38%, p0,03). At logistic regression analysis, hypertension followed by fibrous crescents at biopsy and maintenance without MMF were found as risk factors for the development of CRF. Comparison of survival between patients with CRF to others showed significantly reduced survival in patients with CRF after 20 years ( 64 vs 90%; p=0,02).
Flares and chronic renal failure have a negative impact on the outcome. Cyclophosphamide usage for remission induction, MMF for maintenance and tight control of hypertension may reduce the risk of flares and development of CRF. Renal histopathologic features can be a predictive tool for renal outcome.
To cite this abstract, please use the following information:
Artim-Esen, Bahar, Ozluk, Yasemin, Kilicaslan, Isin, Omma, Ahmet, Pehlivan, Özlem, Inanc, Murat; Analysis of Risk Factors for Relapses and Chronic Renal Failure in Lupus Nephritis: Long Term Follow-up of Biopsy Proven 172 Patients Followed at a Single Center. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2300