Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/3339 |
Resumo: | INTRODUCTION: Lupus nephritis is a serious complication of systemic lupus erythematosus. Currently, therapy is guided by findings in the renal biopsy, following the International Society of Nephrology / Renal Pathology Society classification. Austin and Hill's histomorphological indexes are not routinely obtained. In this retrospective single-centre study, we aimed to analyze the importance and applicability of the different morphological indexes in predicting response to treatment and prognosis. MATERIAL AND METHODS: Patients with kidney biopsy demonstrating lupus nephritis from the 2010 - 2016 period were included. We analyzed their demographic data, comorbidities, clinical presentation and laboratorial evaluation at the time of renal biopsy. We evaluated the following outcomes: clinical remission, renal function and proteinuria at end of follow-up. Histologic analysis was performed using the International Society of Nephrology / Renal Pathology Society classification and the morphological indexes described by Austin (Activity and Chronicity) and Hill. Univariate and multivariate statistical analysis was performed using STATA software. RESULTS: We analyzed 46 biopsy-proven lupus nephritis cases, with a median follow-up of 31.9 (13.2 - 45.6) months. Based on biopsy findings, 35 patients were started on immunosuppressive therapy. We observed that Class IV patients had, at presentation, lower estimated glomerular filtration rate (67.3 vs 94.6 mL/min; p = 0.02), higher proteinuria (4.26 vs 2.37 g/24 hours; p = 0.02) and a non-significantly higher C3 consumption (58.9 vs 77.4 mg/dL; p = 0.06). We did not observe correlations between International Society of Nephrology / Renal Pathology Society classification and the outcomes at the end of follow-up. In contrast, both the Hill biopsy index and Austin's Chronicity index were correlated with renal function and proteinuria at the end of follow-up. Austin's Activity index correlated with the immunological findings (C3, C4 and anti-dsDNA) at presentation. DISCUSSION: Because clinical activity poorly correlates with histologic activity, histological findings are fundamental when assessing patients with suspected lupus nephritis. The most recent International Society of Nephrology / Renal Pathology Society report supports the European League Against Rheumatism guidelines, encouraging the adoption of histomorphological indexes when evaluating lupus nephritis. Our data, showing a correlation between the renal outcomes and the indexes described by Austin and Hill, supports this view. CONCLUSION: The histomorphological indexes in lupus nephritis are easily obtainable, can predict renal outcomes and may help in the management of such patients. |
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Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective StudyÍndices Morfológicos na Nefrite Lúpica: Orientação Prognóstica? Um Estudo RetrospectivoHCC NEFBiopsyAnalysis of VarianceComplement C3/metabolismGlomerular Filtration RateFollow-Up StudiesPrognosisImmunosuppressive Agents/therapeutic useKidney/pathologyKidney/physiopathologyLupus Erythematosus, Systemic/complicationsLupus Nephritis/classificationLupus Nephritis/pathologyLupus Nephritis/physiopathologyLupus Nephritis/therapyProteinuria/diagnosisProteinuria/epidemiologyRemission InductionRetrospective StudiesTreatment OutcomeINTRODUCTION: Lupus nephritis is a serious complication of systemic lupus erythematosus. Currently, therapy is guided by findings in the renal biopsy, following the International Society of Nephrology / Renal Pathology Society classification. Austin and Hill's histomorphological indexes are not routinely obtained. In this retrospective single-centre study, we aimed to analyze the importance and applicability of the different morphological indexes in predicting response to treatment and prognosis. MATERIAL AND METHODS: Patients with kidney biopsy demonstrating lupus nephritis from the 2010 - 2016 period were included. We analyzed their demographic data, comorbidities, clinical presentation and laboratorial evaluation at the time of renal biopsy. We evaluated the following outcomes: clinical remission, renal function and proteinuria at end of follow-up. Histologic analysis was performed using the International Society of Nephrology / Renal Pathology Society classification and the morphological indexes described by Austin (Activity and Chronicity) and Hill. Univariate and multivariate statistical analysis was performed using STATA software. RESULTS: We analyzed 46 biopsy-proven lupus nephritis cases, with a median follow-up of 31.9 (13.2 - 45.6) months. Based on biopsy findings, 35 patients were started on immunosuppressive therapy. We observed that Class IV patients had, at presentation, lower estimated glomerular filtration rate (67.3 vs 94.6 mL/min; p = 0.02), higher proteinuria (4.26 vs 2.37 g/24 hours; p = 0.02) and a non-significantly higher C3 consumption (58.9 vs 77.4 mg/dL; p = 0.06). We did not observe correlations between International Society of Nephrology / Renal Pathology Society classification and the outcomes at the end of follow-up. In contrast, both the Hill biopsy index and Austin's Chronicity index were correlated with renal function and proteinuria at the end of follow-up. Austin's Activity index correlated with the immunological findings (C3, C4 and anti-dsDNA) at presentation. DISCUSSION: Because clinical activity poorly correlates with histologic activity, histological findings are fundamental when assessing patients with suspected lupus nephritis. The most recent International Society of Nephrology / Renal Pathology Society report supports the European League Against Rheumatism guidelines, encouraging the adoption of histomorphological indexes when evaluating lupus nephritis. Our data, showing a correlation between the renal outcomes and the indexes described by Austin and Hill, supports this view. CONCLUSION: The histomorphological indexes in lupus nephritis are easily obtainable, can predict renal outcomes and may help in the management of such patients.Ordem dos MédicosRepositório do Centro Hospitalar Universitário de Lisboa Central, EPENavarro, DFerreira, ACViana, HCarvalho, FNolasco, F2019-10-25T10:18:18Z2019-10-012019-10-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/3339engActa Med Port. 2019 Oct 1;32(10):635-640.10.20344/amp.11598info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:42:28Zoai:repositorio.chlc.min-saude.pt:10400.17/3339Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:20:39.278624Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study Índices Morfológicos na Nefrite Lúpica: Orientação Prognóstica? Um Estudo Retrospectivo |
title |
Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study |
spellingShingle |
Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study Navarro, D HCC NEF Biopsy Analysis of Variance Complement C3/metabolism Glomerular Filtration Rate Follow-Up Studies Prognosis Immunosuppressive Agents/therapeutic use Kidney/pathology Kidney/physiopathology Lupus Erythematosus, Systemic/complications Lupus Nephritis/classification Lupus Nephritis/pathology Lupus Nephritis/physiopathology Lupus Nephritis/therapy Proteinuria/diagnosis Proteinuria/epidemiology Remission Induction Retrospective Studies Treatment Outcome |
title_short |
Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study |
title_full |
Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study |
title_fullStr |
Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study |
title_full_unstemmed |
Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study |
title_sort |
Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study |
author |
Navarro, D |
author_facet |
Navarro, D Ferreira, AC Viana, H Carvalho, F Nolasco, F |
author_role |
author |
author2 |
Ferreira, AC Viana, H Carvalho, F Nolasco, F |
author2_role |
author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Navarro, D Ferreira, AC Viana, H Carvalho, F Nolasco, F |
dc.subject.por.fl_str_mv |
HCC NEF Biopsy Analysis of Variance Complement C3/metabolism Glomerular Filtration Rate Follow-Up Studies Prognosis Immunosuppressive Agents/therapeutic use Kidney/pathology Kidney/physiopathology Lupus Erythematosus, Systemic/complications Lupus Nephritis/classification Lupus Nephritis/pathology Lupus Nephritis/physiopathology Lupus Nephritis/therapy Proteinuria/diagnosis Proteinuria/epidemiology Remission Induction Retrospective Studies Treatment Outcome |
topic |
HCC NEF Biopsy Analysis of Variance Complement C3/metabolism Glomerular Filtration Rate Follow-Up Studies Prognosis Immunosuppressive Agents/therapeutic use Kidney/pathology Kidney/physiopathology Lupus Erythematosus, Systemic/complications Lupus Nephritis/classification Lupus Nephritis/pathology Lupus Nephritis/physiopathology Lupus Nephritis/therapy Proteinuria/diagnosis Proteinuria/epidemiology Remission Induction Retrospective Studies Treatment Outcome |
description |
INTRODUCTION: Lupus nephritis is a serious complication of systemic lupus erythematosus. Currently, therapy is guided by findings in the renal biopsy, following the International Society of Nephrology / Renal Pathology Society classification. Austin and Hill's histomorphological indexes are not routinely obtained. In this retrospective single-centre study, we aimed to analyze the importance and applicability of the different morphological indexes in predicting response to treatment and prognosis. MATERIAL AND METHODS: Patients with kidney biopsy demonstrating lupus nephritis from the 2010 - 2016 period were included. We analyzed their demographic data, comorbidities, clinical presentation and laboratorial evaluation at the time of renal biopsy. We evaluated the following outcomes: clinical remission, renal function and proteinuria at end of follow-up. Histologic analysis was performed using the International Society of Nephrology / Renal Pathology Society classification and the morphological indexes described by Austin (Activity and Chronicity) and Hill. Univariate and multivariate statistical analysis was performed using STATA software. RESULTS: We analyzed 46 biopsy-proven lupus nephritis cases, with a median follow-up of 31.9 (13.2 - 45.6) months. Based on biopsy findings, 35 patients were started on immunosuppressive therapy. We observed that Class IV patients had, at presentation, lower estimated glomerular filtration rate (67.3 vs 94.6 mL/min; p = 0.02), higher proteinuria (4.26 vs 2.37 g/24 hours; p = 0.02) and a non-significantly higher C3 consumption (58.9 vs 77.4 mg/dL; p = 0.06). We did not observe correlations between International Society of Nephrology / Renal Pathology Society classification and the outcomes at the end of follow-up. In contrast, both the Hill biopsy index and Austin's Chronicity index were correlated with renal function and proteinuria at the end of follow-up. Austin's Activity index correlated with the immunological findings (C3, C4 and anti-dsDNA) at presentation. DISCUSSION: Because clinical activity poorly correlates with histologic activity, histological findings are fundamental when assessing patients with suspected lupus nephritis. The most recent International Society of Nephrology / Renal Pathology Society report supports the European League Against Rheumatism guidelines, encouraging the adoption of histomorphological indexes when evaluating lupus nephritis. Our data, showing a correlation between the renal outcomes and the indexes described by Austin and Hill, supports this view. CONCLUSION: The histomorphological indexes in lupus nephritis are easily obtainable, can predict renal outcomes and may help in the management of such patients. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-10-25T10:18:18Z 2019-10-01 2019-10-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/3339 |
url |
http://hdl.handle.net/10400.17/3339 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Acta Med Port. 2019 Oct 1;32(10):635-640. 10.20344/amp.11598 |
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info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Ordem dos Médicos |
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Ordem dos Médicos |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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