Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Study

Detalhes bibliográficos
Autor(a) principal: Navarro, David
Data de Publicação: 2019
Outros Autores: Ferreira, Ana Carina, Viana, Helena, Carvalho, Fernanda, Nolasco, Fernando
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598
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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spelling Morphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective StudyÍndices Morfológicos na Nefrite Lúpica: Orientação Prognóstica? Um Estudo RetrospetivoBiopsyKidney/pathologyLupus ErythematosusSystemic/complicationsLupus Nephritis Predictive Value of TestsPrognosisBiópsiaLupus Eritematoso Sistémico/complicaçõesNefrite LúpicaPrognósticoRim/patologiaValor Preditivo dos TestesIntroduction: 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.Introdução: A nefrite lúpica é uma complicação grave do lúpus eritematoso sistémica. Atualmente, a terapêutica dirigida é ditada pelos achados histológicos da biópsia renal, através da classificação da International Society of Nephrology / Renal Pathology Society. Os índices histomorfológicos descritos por Austin e Hill não são rotineiramente realizados. Neste estudo retrospetivo unicêntrico, procurámos analisar a aplicabilidade e relevância dos índices morfológicos na predição da resposta à terapêutica e do prognóstico em doentes com nefrite lúpica.Material e Métodos: Foram incluídos doentes cuja biópsia renal, realizada entre 2010 e 2016, documentava nefrite lúpica. Analisámos os dados demográficos, comorbilidades, apresentação clínica e avaliação laboratorial destes doentes correspondente à altura da biópsia renal. Avaliámos os seguintes outcomes: remissão clínica, função renal e proteinúria no final do seguimento. A avaliação histológica foi realizada segundo a classificação da International Society of Nephrology / Renal Pathology Society e aplicando os índices morfológicos descritos por Austin (Actividade e Cronicidade) e Hill. A análise estatística univariada e multivariada foi realizada com software STATA.Resultados: Foram revistos 46 casos de nefrite lúpica, com um follow-up mediano de 31,9 (13,2 – 45,6) meses. A partir dos achados histológicos, 35 doentes foram submetidos a imunossupressão. Observámos que os doentes com nefrite lúpica Classe IV tinham, à apresentação, taxa de filtrado glomerular estimada mais reduzida (67,3 vs 94,6 mL/min; p = 0,02), proteinúria mais elevada (4,26 vs 2,37 g/24 horas; p = 0,02) e consumo de C3 mais elevado de modo não-significativo (58,9 vs 77,4 mg/dL; p = 0,06). Não se verificou correlação entre a classificação ISN/RPS e os desfechos no final do follow-up. Por outro lado, tanto o índice de Hill quanto o score de cronicidade de Austin correlacionaram-se com a função renal e a proteinúria no final do seguimento. Adicionalmente, o score de atividade de Austin correlacionou-se com os achados imunológicos à apresentação (C3, C4 e anti-dsDNA).Discussão: Uma vez que a actividade clínica tem fraca correlação com a actividade histológica, os achados histológicos são fundamentais durante a avaliação na suspeita de nefrite lúpica. A mais recente revisão da International Society of Nephrology / Renal Pathology Society vai ao encontro das linhas de orientação da European League Against Rheumatism, encorajando a aplicação de índices histomorfológicos na avaliação da nefrite lúpica. Os dados da nossa população, onde verificámos uma correlação entre o prognóstico renal e os índices histomorfológicos descritos por Austin e Hill, apoiam essa sugestão.Conclusão: Os índices histomorfológicos na nefrite lúpica são de fácil aplicação, conseguem prever os outcomes clínicos e podem representar uma ferramenta adicional na avaliação dos doentes com nefrite lúpica.Ordem dos Médicos2019-10-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentapplication/pdfapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentimage/jpeghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598oai:ojs.www.actamedicaportuguesa.com:article/11598Acta Médica Portuguesa; Vol. 32 No. 10 (2019): October; 635-640Acta Médica Portuguesa; Vol. 32 N.º 10 (2019): Outubro; 635-6401646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/5770https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/10924https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/10960https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/11121https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/11122https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/11352https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/11379Direitos de Autor (c) 2019 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessNavarro, DavidFerreira, Ana CarinaViana, HelenaCarvalho, FernandaNolasco, Fernando2022-12-20T11:06:17Zoai:ojs.www.actamedicaportuguesa.com:article/11598Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:20:03.678523Repositório 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 Retrospetivo
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, David
Biopsy
Kidney/pathology
Lupus Erythematosus
Systemic/complications
Lupus Nephritis Predictive Value of Tests
Prognosis
Biópsia
Lupus Eritematoso Sistémico/complicações
Nefrite Lúpica
Prognóstico
Rim/patologia
Valor Preditivo dos Testes
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, David
author_facet Navarro, David
Ferreira, Ana Carina
Viana, Helena
Carvalho, Fernanda
Nolasco, Fernando
author_role author
author2 Ferreira, Ana Carina
Viana, Helena
Carvalho, Fernanda
Nolasco, Fernando
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Navarro, David
Ferreira, Ana Carina
Viana, Helena
Carvalho, Fernanda
Nolasco, Fernando
dc.subject.por.fl_str_mv Biopsy
Kidney/pathology
Lupus Erythematosus
Systemic/complications
Lupus Nephritis Predictive Value of Tests
Prognosis
Biópsia
Lupus Eritematoso Sistémico/complicações
Nefrite Lúpica
Prognóstico
Rim/patologia
Valor Preditivo dos Testes
topic Biopsy
Kidney/pathology
Lupus Erythematosus
Systemic/complications
Lupus Nephritis Predictive Value of Tests
Prognosis
Biópsia
Lupus Eritematoso Sistémico/complicações
Nefrite Lúpica
Prognóstico
Rim/patologia
Valor Preditivo dos Testes
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 2019-10-01
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dc.language.iso.fl_str_mv eng
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/5770
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/10924
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/10960
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/11121
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/11122
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/11352
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11598/11379
dc.rights.driver.fl_str_mv Direitos de Autor (c) 2019 Acta Médica Portuguesa
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Direitos de Autor (c) 2019 Acta Médica Portuguesa
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dc.publisher.none.fl_str_mv Ordem dos Médicos
publisher.none.fl_str_mv Ordem dos Médicos
dc.source.none.fl_str_mv Acta Médica Portuguesa; Vol. 32 No. 10 (2019): October; 635-640
Acta Médica Portuguesa; Vol. 32 N.º 10 (2019): Outubro; 635-640
1646-0758
0870-399X
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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