Non-albumin proteinuria in lupus nephritis with tubulointerstitial inflammation and its clinical significance

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ashraf Mahmoud Okba ◽  
Nehal Elfawy Mahmoud ◽  
Mariam Maged Amin ◽  
Mariam Ahmed Mohamed Mamdouh
Keyword(s):  
Lupus Nephritis ◽  
Immunosuppressive Treatment ◽  
Prognostic Significance ◽  
Systemic Lupus Erythematosis ◽  
Creatinine Ratio ◽  
Systemic Lupus ◽  
Renal Response ◽  
Case Series Study ◽  
Before And After ◽  
Tubulointerstitial Inflammation

Abstract Background Tubulointerstitial inflammation (TI) associated with systemic lupus erythematosis is an increasing finding in lupus nephritis. TI severity may have prognostic significance in the renal outcomes of lupus nephritis. Here, we aimed to determine whether non-albumin proteinuria is associated with TI severity and with the renal response in lupus nephritis. Objective To investigate the possible association between non-albumin proteinuria, tubulointerstial inflammation severity and poor renal response after immunosuppressive treatment. Patients and Methods This is a case series study which was conducted on 100 patients with systemic lupus erythematosis recruited from the outpatient clinic of Clinical Immunology at Ain Shams University Hospitals. Subject ages were between 13-53 years old, each one was subjected to detailed history, physical examination, laboratory investigations including serum creatinine before and after treatment, protein/creatinine ratio before and after treatment, albumin/creatinine ratio, ESR, CRP, CBC, C3 C4, anti DNA, eGFR and renal biopsy Results Our results showed that non-albumin proteinuria (uPCR − uACR) was significantly higher in patients with moderate-to-severe TI than in patients with no-tomild TI. Further, higher uPCR − uACR levels at baseline were associated with poor renal response after 6 months of treatment. Conclusion we found that non-albumin proteinuria (uPCR-uACR) is associated with severe tubulointerstitial inflammation (TI) in lupus nephritis.

scholarly journals POS0722 HISTOPATHOLOGICAL ANALYSIS OF LUPUS NEPHRITIS INCORPORATING BANFF CRITERIA EMPHASIZES THE IMPORTANCE OF TUBULOINTERSTITIAL CHANGES FOR CREATININE AND PROTEINURIA AT 12 MONTHS AFTER RENAL BIOPSY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 611.1-611
Author(s):  
M. Plüß ◽  
S. Hakroush ◽  
N. Niebusch ◽  
B. Tampe ◽  
P. Korsten
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Interstitial Fibrosis ◽  
Laboratory Data ◽  
Histopathological Analysis ◽  
Systemic Lupus ◽  
Long Term Outcome ◽  
Banff Classification ◽  
Tubulointerstitial Inflammation

Background:Lupus nephritis (LN) occurs in about 30-60% of patients with systemic lupus erythematosus (SLE). LN is associated with increased mortality. Currently, the diagnosis relies on histopathologic characteristics according to the ISN/RPS classification (1). This classification relies heavily on glomerular changes and may not accurately reflect all changes occurring in LN. For the description of transplanted kidney, the BANFF classification has been established which, in addition to glomerular changes, also incorporates tubular pathologies (2).Objectives:With the present study, we aim to describe histopathologic changes according to the BANFF classification in a single-center cohort of LN patients.Methods:We retrospectively recorded epidemiological, clinical and laboratory data of 58 patients with LN over a ten-year period. Histopathologic diagnoses according to ISN/RPS classification or the former WHO classification were also documented. We then re-analyzed representative kidney samples according to the BANFF classification and performed Spearman rank correlation for BANFF findings and creatinine at biopsy and 12 months as well as proteinuria at biopsy and at 12 months.Results:We analyzed 58 patients with LN. 9 were male, 49 were female. Median age was 38 (15-78) years. According to ISN/RPS, 3 had class I LN, 6 had class II, 14 had class III, 16 had class IV, 6 had class V, and 0 had class VI. Median eGFR at biopsy was 60 ml/min/1.73m2 (13-137). According to the BANFF classification, tubulointerstitial inflammation (ti) was associated with creatinine at 12 months. Proteinuria at 12 months was associated with interstitial fibrosis (ci) (Figure 1).Conclusion:In LN, the current ISN/RPS classification puts emphasis on glomerular changes. Nevertheless, for the long-term outcome, tubulointerstitial changes (tubulointerstitial inflammation and interstitial fibrosis) may at least be as important as glomerular changes. These findings have to be corroborated in larger cohorts with prespecified renal endpoints.References:[1]Weening et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. JASN 2004.[2]Jeong HY. Diagnosis of renal transplant rejection: Banff classification and beyond. Kidney Res Clin Pract 2020.Disclosure of Interests:Marlene Plüß: None declared, Samy Hakroush: None declared, Noah Niebusch: None declared, Björn Tampe: None declared, PETER KORSTEN Speakers bureau: Abbvie, Pfizer, Chugai, Sanofi, Boehringer-Ingelheim, GSK, Novartis, Consultant of: Abbvie, Pfizer, Chugai, Sanofi, Boehringer-Ingelheim, GSK, Novartis, Lilly, Gilead, Grant/research support from: GSK

scholarly journals P0429OUTCOMES OF LUPUS NEPHRITIS OVER AN ERA OF EVOLVING IMMUNOSUPPRESSION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jason McMinn ◽  
Colin C Geddes ◽  
Emily McQuarrie
Keyword(s):  
Lupus Nephritis ◽  
Electronic Patient Record ◽  
Immunosuppressive Treatment ◽  
Complete Response ◽  
Histopathological Diagnosis ◽  
Class V ◽  
Remission Rates ◽  
Induction Regimen ◽  
Before And After

Abstract Background and Aims The reported incidence of lupus nephritis (LN) is approximately 6.1 cases per million population per year in Scotland based on Scottish Renal Registry biopsy data. Despite immunosuppressive treatment, approximately 10-30% of patients will progress to established renal failure (ERF) within 15 years. In December 2007, our unit moved from a protocol of Cyclophosphamide/ steroid induction with Azathioprine/ Prednisolone maintenance to Mycophenolate/ steroid induction and maintenance. We undertook this study to compare remission rates before and after this change. Method A retrospective electronic patient record analysis was performed for all patients in our centre with a documented native renal biopsy showing a histopathological diagnosis of LN, between 1 July 1993 and 31 December 2017. Repeat biopsies were excluded. Baseline demographics, histopathological class and first and second line induction and maintenance therapies were recorded. Endpoints analysed were; partial and complete response (as defined in KDIGO Clinical Practice Guideline for Glomerulonephritis 2012), time to achieve this response, relapse, progression to ERF and death. Results 120 patients who underwent a biopsy during the 24.5-year period received a diagnosis of lupus nephritis. 82.5% of patients were Caucasian. Median duration of follow-up was 72 months. 15% of patients died and 5% developed ERF within the follow-up period, representing one death per 56 patient years and one incident case of ERF per 168 patient years. There were 40 patients in the pre-December 2007 group and 80 in the post-December 2007 group. Those in the earlier group were younger, with a mean age of 35.4 years versus 44.8 years in the later group (p=0.002). 23% had class V in the earlier group compared to 15% in the later group (p=0.31). Proportions of female patients were 80% and 75% in the early and late groups respectively (p=0.54). Median creatinine was 106µmol/L in the pre-December 2007 group and 89.5 µmol/L in the post-December 2007 group (p=0.96). Patients in the pre- and post- December 2007 groups had comparable rates of complete response, at 72% and 71% respectively. However, those diagnosed before December 2007 were slower to respond, with a median time to achieve complete response of 10.5 months, compared to 6 months in those diagnosed after 1 December 2007 (p=0.007). Conclusion Following a change in our immunosuppressive induction regimen from Cyclophosphamide/ steroids to Mycophenolate/ steroids, our response rates have remained similar, however speed of attaining remission has improved.

scholarly journals Renal transplantation for lupus nephritis: non-adherence and graft survival

Lupus ◽  
2019 ◽  
Vol 28 (5) ◽  
pp. 651-657 ◽  
Author(s):  
E Ntatsaki ◽  
V S Vassiliou ◽  
A Velo-Garcia ◽  
A D Salama ◽  
D A Isenberg
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Renal Transplantation ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Graft Rejection ◽  
Graft Failure ◽  
Immunosuppressive Treatment ◽  
Poor Adherence ◽  
Systemic Lupus ◽  
Group 2

Objectives Poor adherence to immunosuppressive treatment is common in patients with systemic lupus erythematosus and may identify those with lupus nephritis (LN) who have a poorer prognosis. Non-adherence has also been reported to be a potential adverse outcome predictor in renal transplantation (rTp). We investigated whether non-adherence is associated with increased rTp graft rejection and/or failure in patients with LN. Methods Patients with LN undergoing rTp in two major London hospitals were retrospectively included. Medical and electronic records were reviewed for documented concerns of non-adherence as well as laboratory biochemical drug levels. The role of non-adherence and other potential predictors of graft rejection/failure including demographics, comorbidities, age at systemic lupus erythematosus and LN diagnosis, type of LN, time on dialysis prior to rTp and medication use were investigated using logistic regression. Results Out of 361 patients with LN, 40 had rTp. During a median follow-up of 8.7 years, 17/40 (42.5%) of these patients had evidence of non-adherence. A total of 12 (30.0%) patients experienced graft rejection or failure or both. In the adherent group 2/23 (8.7%) had graft rejection, whilst in the non-adherent this rose to 5/17 (29.4%, p = 0.11). Graft failure was seen in 5/23 (21.7%) patients from the adherent group and 4/17 (23.5%) in the non-adherent group ( p = 0.89). Non-adherent patients had a trend towards increased graft rejection, hazard ratio 4.38, 95% confidence interval = 0.73–26.12, p = 0.11. Patients who spent more time on dialysis prior to rTp were more likely to be adherent to medication, p = 0.01. Conclusion Poor adherence to immunosuppressive therapy is common and has been shown to associate with a trend towards increased graft failure in patients with LN requiring rTp. This is the first paper to report that shorter periods on dialysis prior to transplantation might lead to increased non-adherence in lupus patients.

Gastrointestinal vasculitis due to systemic lupus erythematosus treated with rituximab: a case report

Lupus ◽  
2020 ◽  
Vol 29 (6) ◽  
pp. 640-643
Author(s):  
Gökçe Kenar ◽  
Kadri Atay ◽  
Gül Emek Yüksek ◽  
Burak Öz ◽  
Süleyman Serdar Koca
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Pain ◽  
Case Report ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Immunosuppressive Treatment ◽  
Rapid Progression ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Systemic Lupus

Background Patients with systemic lupus erythematosus may present with variable gastrointestinal manifestations including peritonitis, pancreatitis, enteritis, and vasculitis. Gastrointestinal vasculitis is one of the most devastating complications of systemic lupus erythematosus, with a mortality rate of 50% when it progresses to bowel ischemia and is complicated by hemorrhage or perforation. Case report A young female patient known to have systemic lupus erythematosus, lupus nephritis, and antiphospholipid antibody syndrome, on immunosuppressive treatment presented to the emergency department with acute abdominal pain and nausea. The clinical findings were first associated with an acute flare of lupus nephritis according to the assessments with active laboratory parameters. However, over a short time the abdominal pain worsened and was accompanied by peritonitis and gastrointestinal hemorrhage. The computed tomography scans demonstrated a dilated bowel and thickening of the bowel compatible with gastrointestinal vasculitis. The upper and lower gastrointestinal endoscopy supported the diagnosis of vasculitis by showing multiple ulcerative lesions along the gastrointestinal tract. The patient was successfully treated with pulse corticosteroids urgently, with a fast response to subsequent rituximab therapy without any relapses. Treatment with cyclophosphamide was not preferred because the patient had a high cumulative dose. Conclusion Gastrointestinal vasculitis should be a primary differential diagnosis in patients with systemic lupus erythematosus presenting with abdominal pain because of its rapid progression and high mortality. The treatment choice has been suggested as cyclophosphamide for severe cases in the literature. In this case report, a patient successfully treated with rituximab without any relapses was documented.

scholarly journals P0266PREDICTIVE FACTORS OF COMPLETE RENAL RESPONSE IN PROLIFERATIVE LUPUS NEPHRITIS: A COLLABORATIVE STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Beatriz Sanchez Alamo ◽  
Clara Maria Cases Corona ◽  
Serena Gatius ◽  
Patricia Dominguez Torres ◽  
Elena Valdes ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Lupus Nephritis ◽  
Kidney Biopsy ◽  
Univariate Analysis ◽  
Immunosuppressive Treatment ◽  
Collaborative Study ◽  
Class Iii ◽  
Renal Response ◽  
Proliferative Lupus Nephritis

Abstract Background and Aims Proliferative lupus nephritis (class III and IV) is the most severe form of lupus nephritis and requires prompt diagnosis and treatment with immunosuppressive therapy. Since it represents the most serious entity and has the greatest functional consequences there is a need to determine which factors in proliferative lupus nephritis are most predictive of good long-term renal function. Method Methods We analysed the data of 49 biopsy-proven proliferative lupus nephritis (18,4% class III and 81,6% class IV) of three different Spanish hospitals to find prognostic factors for complete renal response (CRR), defined as loss of <25% of eGFR and the absence of proteinuria and microhematuria at the end of the follow up. Sociodemographic, clinical, laboratory, and treatment-related data at the time of kidney biopsy and during follow-up were obtained. We performed univariate analysis and logistic regression to identify independent risk factors. Results The median follow-up was 8 years (IQR: 3-12,5), during which time 18 patients (36,7 %) achieved CRR. In the univariate analysis complete renal response was related to: (1) at the diagnosis to: age [40,52 (11,29) years vs 29,92 (11,93) p=0,004]; (2) in kidney biopsy to less leukocyte infiltration (42,3% p=0,05); (3) during the follow up to: less comorbities (27,8% vs 64,3% p=0,02), less infections (27,8% vs 58,6% p=0,04) and less hospitalizations due to infections (0% vs 33,3% p=0,010), less prevalence of high BP (22,2% vs 60,7% p=0,01), (4) at the end of follow up to : serum albumin [3,97 (0,59) vs 4,31(0,19) mg/dL p=0,03]. In the logistic regression comorbidies (HR : 5,71 95%IC: 1,56-20,93 p=0,008) and age at the moment of diagnosis (HR : 1,046 95%IC:1,001-1,071 p=0,04) were related to complete renal response. We didn´t find any differences concerning treatments. Conclusion Proliferative lupus nephritis is one of the most severe manifestations of lupus nephritis, resulting in increased morbidity and mortality. Traditionally it has been thought that older patients have a worst prognosis, however we demonstrated that they achieved more frequently CRR. In the management of the patients traditional reno protective measures like strict control of BP must be considered since it is a predictive factor of CRR. We shouldn´t forget about the implications of an aggressive immunosuppressive treatment such as hospitalizations due to infections and comorbities.

scholarly journals AB0299 QUANTITATIVE EVALUATION OF PROTEINURIA WITH URINALYSIS TEST AND COMPARING ITS CORRELATION WITH RANDOM SPOT URINE PROTEIN-CREATININE RATIO AND 24 HOUR URINE PROTEIN IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS –A SINGLE CENTRE EXPERIENCE IN MALAYSIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1176.1-1176
Author(s):  
C. R. Ng ◽  
Y. L. Loh
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Standard Test ◽  
Protein Quantification ◽  
Nephrol Dial Transplant ◽  
Creatinine Ratio ◽  
Systemic Lupus ◽  
Urine Protein ◽  
Spot Urine

Background:Lupus nephritis is an important concern among Systemic Lupus Erythematosus (SLE) patients in Asia and its mortality rate was reported to be 6 times higher compared to the general population [1]. Without prompt treatment it can lead to end stage renal failure and affect quality of life. 24 hour urine protein collection has long been used as the gold standard test to assess proteinuria. However due to its cumbersome process random spot urine protein-creatinine ratio is used as an alternative to replace the former in some centres before subjecting patients to renal biopsy. In a study done by Matar HE et al in 2012, he showed that there was a significant correlation between 24 hour urine protein and urine protein creatinine ratio in his 95 subjects [2].Urinalysis is a semi-quantitative screening tool for early detection of potential kidney disorders. A survey done by Siedner MJ et al on practice preferences among American Rheumatologists in 2005 reported that 64.6% of them preferred to use urinalysis as the primary tool to screen for proteinuria [3].Objectives:To assess the correlation of urinalysis test with random spot urine protein-creatinine ratio PCR) compared with 24 hour urine protein.Methods:This was a retrospective study. The electronic medical records of all SLE patients seen in the rheumatology clinic of Hospital Sultan Ismail from 1/1/2017 to 31/12/2020 were reviewed. Patients who had urinalysis, urine protein creatinine ratio and 24 hour urine protein tests done were identified. Data on demography, urinalysis, random spot urine protein creatinine ratio and 24 hour urine protein were obtained and analysed.Results:There were a total of 131 patients and 124 were females. The majority were Malays (75/131) followed by the Chinese (45/131),Indians (9/141) and others (2/131). The mean age group for the studied subjects was 34 (13-67). The urinalysis test showed that 34 of them had negative results, 37 of them had urine protein of 1 +, 18 of them had urine protein of 2+ followed by 23 patients with urine protein of 3 + and the rest had urine protein of 4+. The correlation between urinalysis and 24 hour urine protein was strong (r = 0.702), whereas the correlation between urinalysis and urine PCR ratio was stronger (r = 0.797).Conclusion:We conclude that urinalysis correlates well with both random spot urine protein creatinine ratio and 24 hour urine protein and the correlation is stronger with urine PCR.References:[1]Yap DY, Tang CS, Ma MK, Lam MF, Chan TM. Survival analysis and causes of mortality in patients with lupus nephritis. Nephrol Dial Transplant. 2012;27:3248–3254. [PubMed][2]Matar HE, Peterson P, Sangle S, D’Cruz DP. Correlation of 24-hour urinary protein quantification with spot urine protein: creatinine ratio in lupus nephritis. Lupus 2012 Jul;21(8): 836-9. doi:10.1177/0961203312437438. Epub 2012 Feb 13.[3]Siedner MJ, Christopher-Stine L, Astor BC, Gelber AC, Fine DM. Screening for proteinuria in patients with lupus: a survey of practice preferences among American rheumatologists. J Rheumatol. 2007;34:973–977. [PubMed].Disclosure of Interests:None declared

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