scholarly journals Explanatory histological findings for urinary protein and serum creatinine levels at renal biopsy in lupus nephritis: A cross-sectional study

2020 ◽  
Author(s):  
Eri Katsuyama ◽  
Yoshia Miyawaki ◽  
Kenei Sada ◽  
Yosuke Asano ◽  
Keigo Hayashi ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Renal Biopsy ◽  
Multiple Regression ◽  
Interstitial Fibrosis ◽  
Urinary Protein ◽  
Glomerular Sclerosis ◽  
Fibrinoid Necrosis ◽  
Class Iii ◽  
The Mean

Abstract Background To evaluate histological active and chronic lesions associated with proteinuria and serum creatinine (SCr) level as common clinical endpoints in many clinical trials for lupus nephritis (LN).Methods One hundred and nineteen patients from 1990 to 2015 with LN class III, IV, and V, as defined by the International Society of Nephrology/Renal Pathology Society classification, were enrolled. Multiple regression analysis was performed to explore semiquantitative histological variables related to urinary protein and SCr levels.Results The mean age of enrolled patients was 45 years and 79% were female. The mean SCr level was 0.87 mg/dl and mean urinary protein was 3.00 g/gCr at the time of the renal biopsy. Class IV (71%) was the most common type, followed by class III (17%) and class V (13%). Multicollinearity was confirmed between monocellular infiltration (variance inflation factor [VIF] = 10.22) and interstitial fibrosis (VIF = 10.29) and between karyorrhexis (VIF = 4.14) and fibrinoid necrosis (VIF = 4.29). After excluding fibrinoid necrosis and monocellular infiltration because of multicollinearity, only urinary protein level was correlated with wire loop (β−coefficient [β]: 1.09 and confidence interval [CI]: 0.35 to 1.83), and SCr level was correlated with glomerular sclerosis (β: 1.08 and CI: 0.43 to 1.74) by multiple regression analysis.Conclusion As urinary protein and SCr levels could not reflect active lesions quantitatively, they might be difficult to be evaluated for response to induction remission treatments in patients with LN.

scholarly journals Explanatory histological findings for urinary protein and serum creatinine levels at renal biopsy in lupus nephritis: A cross-sectional study

2020 ◽  
Author(s):  
Eri Katsuyama ◽  
Yoshia Miyawaki ◽  
Ken-ei Sada ◽  
Yosuke Asano ◽  
Keigo Hayashi ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Renal Biopsy ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Urinary Protein ◽  
Fibrinoid Necrosis ◽  
Class Iii ◽  
The Mean

Abstract Background To evaluate histological active and chronic lesions associated with proteinuria and serum creatinine (SCr) level as common clinical endpoints in many clinical trials for lupus nephritis (LN). Methods One hundred and nineteen patients from 1990 to 2015 with LN class III, IV, and V, as defined by the International Society of Nephrology/Renal Pathology Society classification, were enrolled. Multiple regression analysis was performed to explore semiquantitative histological variables related to urinary protein and SCr levels. Results The mean age of enrolled patients was 45 years and 79% were female. The mean SCr level was 0.87 mg/dl and mean urinary protein was 3.00 g/gCr at the time of the renal biopsy. Class IV (71%) was the most common type, followed by class III (17%) and class V (13%). Multicollinearity was confirmed between monocellular infiltration (variance inflation factor [VIF] = 10.22) and interstitial fibrosis (VIF = 10.29) and between karyorrhexis (VIF = 4.14) and fibrinoid necrosis (VIF = 4.29). After excluding fibrinoid necrosis and monocellular infiltration because of multicollinearity, only urinary protein level was correlated with wire loop (β−coefficient [β]: 1.09 and confidence interval [CI]: 0.35 to 1.83), and SCr level was correlated with glomerular sclerosis (β: 1.08 and CI: 0.43 to 1.74) by multiple regression analysis. Conclusion As urinary protein and SCr levels could not reflect active lesions quantitatively, they might be difficult to be evaluated for response to induction remission treatments in patients with LN.

scholarly journals A study on the relationship between morphological lesions of lupus nephritis with demographic and biochemical findings

2021 ◽  
Vol 7 (1) ◽  
pp. e10-e10
Author(s):  
Nasrin Tavassoli ◽  
Hamid Nasri ◽  
Rohollah Valizadeh
Keyword(s):  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Lupus Erythematosus ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Glomerular Sclerosis ◽  
Class Iii ◽  
Cross Sectional ◽  
The Mean

Introduction: Lupus nephritis is one of the important aspects of systemic lupus erythematosus (SLE). Objectives: This study aimed to investigate possible relationship between pathological lesions of lupus nephritis classes and demographic and biochemical findings among patients. Patients and Methods: This is a cross-sectional study that was conducted on a group of renal biopsy proven lupus nephritis patients using lupus nephritis classification of ISN/RPS 2003. We collected demographic data of all patients including age, gender serum creatinine and 24h proteinuria. Results: Data of 101 patients, of whom 78 (77.23%) were females and mean age of 33.54±13.15 years. The mean serum creatinine and proteinuria were 1.54±0.88 mg/dL 2502.5±1495.05 mg/d. Based on our data, IV-G (class IV, diffuse lupus nephritis-global) lupus nephritis class was the most common (39.6%) followed by class III (23.8%). The mean crescent and sclerotic glomeruli were 1.66±3.32 and 2.27±5.32, respectively. In this study, 24 hours proteinuria, serum creatinine, activity percent, chronicity percent, crescent and glomerular sclerosis between genders showed no significant differences (P>0.05). The correlation between plasma creatinine and activity was directly positive and significant (r=0.381, P=0.001). In addition, a significant correlation between C1q deposits and glomerular sclerosis (P=0.031) was detected. Accordingly, a significant correlation between IgG deposits and lupus nephritis classification (P=0.025) was seen. Conclusion: Lupus nephritis of IV-G and III classes of lupus nephritis were most common among patients and higher IgG deposits were observed in patients with IV-G classification. We found a significant correlation between glomerular sclerosis and C1q deposits that could be an indicator of lupus nephritis activity and severity. However, we recommend further studies in this regard.

P0409CHARACTERISTICS AND OUTCOME OF ONE HUNDRED EGYPTIAN PATIENTS OF LUPUS NEPHRITIS: A SINGLE TERTIARY CARE CENTER STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mohammed Saleh ◽  
Mohammed Kamal Nassar ◽  
Ehab Awad
Keyword(s):  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Renal Biopsy ◽  
Interstitial Fibrosis ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Renal Recovery ◽  
University Hospital ◽  
Dialysis Unit ◽  
Chronicity Index

Abstract Background and Aims Renal biopsy is the “gold standard” for diagnosis of lupus nephritis (LN). It is necessary for classification and is the basis for treatment strategy decisions. This study was carried out in order to analyse the results of renal biopsy in LN patients, its effect on treatment and predictors for remission in an Egyptian cohort. Method The results of renal biopsies of LN patients undergoing regular follow up in the outpatient clinic of Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University Hospital, Egypt in the period between October 2017 and September 2019 were reviewed. The histopathological data were analyzed and correlated to the clinical data of the study group. Results A total of 100 LN patients with documented renal biopsy were enrolled in this study. The median age of the patients was 29 years. Most of the patients were females (n=89). Serum creatinine at presentation ranged from 0.57 to 13.5 mg/dl (median 1.3 mg/dl). Class IV (diffuse proliferative) LN was the most frequently encountered class, followed by Classes III, V, II and VI respectively, while class I was detected in only one patient. In proliferative classes (III and IV), the total score of activity indices, ranged from 0 to 16 (minimum–maximum). Mesangial hypercellularity was the most frequent encountered active lesions. Total score of chronicity indices ranged from 0 to 10 (minimum-maximum). Interstitial fibrosis was the most frequent chronicity index. Remission was achieved in 73 patients. Patients who achieved remission had lower serum creatinine and lower pathological chronicity score. In a multivariate logistic regression analysis, serum creatinine at presentation was the strongest predictor for renal remission in this cohort and chronicity index was the strongest predictor in proliferative classes (III and IV). Receiver operating characteristic curve (ROC curve) was done to identify the cutoff point of serum creatinine which can indicate the probability of renal recovery in proliferative and non-proliferative classes (n=100) and in proliferative classes only (n=73). A serum creatinine value of 1.65 mg/dl or less identifies the probability of renal recovery with 76% sensitivity and 71% specificity in proliferative and non-proliferative classes . A chronicity index value of 6 or less identifies the probability of renal recovery with 93% sensitivity and 58% specificity. Conclusion Renal biopsy is a must in LN to guide treatment and prognosis. In this Egyptian cohort, serum creatinine at presentation and pathological chronicity index score are the strongest predictors of renal response in LN patients.

Frequency of Histopathological patterns of Lupus Nephritis according to classification by WHO among Pakistani patients

2021 ◽  
Vol 15 (9) ◽  
pp. 2343-2344
Author(s):  
Aijaz Z. Khan Chachar ◽  
Miqdad Haider ◽  
Naveed A. Lashari ◽  
M. Mueed Yasin ◽  
Hafiz B. A. Kalhoro ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Lupus Erythematosus ◽  
Who Classification ◽  
Correct Diagnosis ◽  
Class Ii ◽  
Class Iii ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Cross Sectional

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder, multisystemic in nature more common in females of childbearing age. There are certain risk factors which predispose to this disease. It affects various organs, kidney is among them. Almost 60% patients having SLE ultimately leads to kidney dysfunction at some stage of the life. Aim: To find out pattern of histopathological findings of lupus nephritis as per WHO classification on kidney biopsy in Pakistan. Methodology: This cross-sectional study was completed in department of Medicine, Fatima Memorial Hospital, Lahore, from March 2016 to May, 2018. Total sample size was 165 patients. Only patients who fulfilled the 2012 SLICC (Systemic Lupus International Collaborating Clinics) criteria were included in the study. SPSS version 25.0 was used data analysis. Results: Age of the patients was between 31-50 years i.e. 114(69.09%), mean and SD was 43.96±4.84 years, females were more commonly affected by calculating 99(59.70%). Patterns of lupus nephritis as per WHO classification and renal biopsy were noted which shows 18(10.91%) had Class I, 53(32.12%) Class II, 43(26.07%) Class III, 35(21.20%) Class IV, 10(6.06%) Class V and 6(3.64%) had Class VI. Conclusion: Class II and Class III Lupus Nephritis are the most common modalities found in patients of SLE. Every patient with Lupus Nephritis should undergo a Renal Biopsy for correct diagnosis of the class of this disease and further management accordingly. Keywords: Lupus Nephritis, SLE, renal biopsy

The Relevance of Periglomerular Fibrosis in the Evaluation of Routine Needle Core Renal Biopsies

2011 ◽  
Vol 135 (1) ◽  
pp. 117-122
Author(s):  
Joseph Jenkins ◽  
Sergey V. Brodsky ◽  
Anjali A. Satoskar ◽  
Gyongyi Nadasdy ◽  
Tibor Nadasdy
Keyword(s):  
Renal Function ◽  
Renal Biopsy ◽  
Renal Injury ◽  
Interstitial Fibrosis ◽  
Renal Diseases ◽  
Glomerular Sclerosis ◽  
Poor Renal Function ◽  
Renal Biopsies ◽  
Biopsy Report ◽  
Relationship Of

Abstract Context—Renal interstitial fibrosis and, to a lesser extent, sclerotic glomeruli correlate with poor renal function. However, not all nonfunctional glomeruli are sclerotic. Many or most glomeruli with periglomerular fibrosis, while retaining blood flow, probably do not filter; therefore, they may not contribute to renal function. Objective—To examine the relationship of periglomerular fibrosis and the sum of globally sclerotic glomeruli and glomeruli with periglomerular fibrosis (GSG+PF) with interstitial fibrosis and renal function. Design—Native kidney biopsies from 177 patients with chronic renal injury were assessed for interstitial fibrosis, glomerular sclerosis, and GSG+PF. Renal biopsies with active or acute lesions were not included. The percentage of globally sclerotic glomeruli and GSG+PF was correlated with the degree of interstitial fibrosis and serum creatinine levels. Results—The percentage of GSG+PF correlates better with the degree of interstitial fibrosis and renal function than does the percentage of globally sclerotic glomeruli alone. This appears particularly true in chronic renal diseases of patients without diabetes. The number of globally sclerotic glomeruli correlates better with interstitial fibrosis and renal function than does the sum of globally and segmentally sclerotic glomeruli. Conclusions—The percentage of GSG+PF in a renal biopsy specimen provides a better estimate of chronic renal injury than does the percentage of sclerotic glomeruli alone, probably because many or most glomeruli with periglomerular fibrosis are nonfunctional. Therefore, we recommend that the number of glomeruli with periglomerular fibrosis also be provided in the renal biopsy report.

Wire-loop lesion is associated with serological immune abnormality, but not renal prognosis, in lupus nephritis

Lupus ◽  
2020 ◽  
Vol 29 (4) ◽  
pp. 407-412
Author(s):  
T Zoshima ◽  
S Hara ◽  
I Mizushima ◽  
R Nishioka ◽  
K Ito ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Class Iii ◽  
Tubular Atrophy ◽  
Wire Loop ◽  
Factors Associated ◽  
Clinicopathological Findings ◽  
Renal Prognosis ◽  
Dsdna Antibodies

Background Wire-loop lesion (WL) is one of the active lesions of lupus nephritis (LN). However, few reports have focused on the clinicopathological relationships of WL to serological immune abnormality and renal prognosis. Methods We enrolled 126 Japanese LN patients subjected to renal biopsy in 11 hospitals from 2000 to 2018. In patients with class III or IV of the International Society of Nephrology/Renal Pathology Society classification, we retrospectively compared clinicopathological findings between those with WL (WL+ group) and without WL (WL– group) to detect factors associated with WL. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate of <60 mL/min/1.73m2 for more than three months. We also compared these findings between those with CKD (CKD+ group) and without CKD (CKD– group) at the last visit to investigate factors associated with renal prognosis. Results Of 126 patients, 100 (79.4%) were classified as class III or IV. WL was found in 36 (36.0%) of them. Although the renal function did not differ, the WL+ group had a higher titre of serum anti-dsDNA antibodies and lower serum complement 3 levels than the WL– group. Linear regression analysis revealed a significant association only between anti-dsDNA antibodies and WL (β = 0.27, 95% confidence interval (CI) 0.001–0.100, p = 0.01). Of these patients, 69 were tracked for 59.6 ± 55.1 months. Kaplan–Meier analysis showed no difference in renal prognosis between these groups. Next, the CKD+ group included 15 (22.1%) patients. They were older and had higher frequencies of hypertension and hyperuricaemia, serum creatinine (Cr) level, glomerulosclerosis, interstitial inflammation, interstitial fibrosis and tubular atrophy than the CKD– group at the time of renal biopsy. The frequency of WL was not significantly different. Cox regression analysis revealed significant associations of CKD with hypertension, hyperuricaemia, serum Cr level at the time of renal biopsy clinically and with tubular atrophy histologically. Conclusions WL was associated with serum anti-dsDNA antibodies but not with renal prognosis, suggesting that WL reflects immune abnormality but is not an independent factor predictive of renal prognosis in LN.

P0167HYPERTENSION IN PATIENTS WITH LUPUS NEPHRITIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marwa Omrane ◽  
Raja Aoudia ◽  
Mondher Ounissi ◽  
Mariem Najar ◽  
Mouna Jerbi ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Lupus Erythematosus ◽  
Chronic Renal Disease ◽  
Beta Blockers ◽  
Vascular Lesions ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Channel Blockers ◽  
Class Iii

Abstract Background and Aims Hypertension is a common manifestation during systemic lupus erythematosus (SLE). Its mechanism is multifactorial and microthromboses of renal arterioles seem to be the most important mechanism. The objective of our study is to identify the histological and evolutionary characteristics of patients with lupus nephritis (LN) presenting with hypertension. Method A retrospective study of 85 patients followed for LES with lupus nephritis documented by a renal biopsy collected in 17 years and presenting with hypertension. Results Among 174 patients with LN, eighty-five (48.58%) are hypertensive. A sex ratio F / H of 6.08. The mean age of LN diagnosis was 36.4 years old [13 -75 years old]. The average time to onset of hypertension was 25.8 months [0-204 months]. Malignant hypertension was present in 12% of patients. Antiphospholipid Antibody Syndrome (APLS) was found in 35.3% of cases. Renal biopsy showed LN class II in 2 cases, class III in 8 cases, class IV in 43 cases, class V isolated in 8 cases and class VI in 3 cases. Vascular lesions were arteriolosclerosis in 40% of cases and thrombotic microangiopathy (TMA) lesions in 17.6% of cases. The treatment was essentially based on blockers of the renin angiotensin system, either as monotherapy or in combination with calcium channel blockers, beta blockers or central antihypertensives. The evolution was marked by the occurrence of cerebrovascular accidents associated in 7 cases with APLS and coronary artery disease in 2 cases. Renal evolution was marked by total and durable remission in 27.5%, chronic renal disease in 31.7%, and end-stage renal failure in 40.8% of cases. Blood pressure was balanced in 40,5 % of cases and unbalanced in 59,5% of cases. Conclusion In our lupus patients, hypertension was common, associated with severe glomerular and vascular lesions and a rather severe renal prognosis.

scholarly journals Repeated Renal Biopsy - A Predictive Tool to Assess the Probability of Renal Flare in Lupus Nephritis

2016 ◽  
Vol 44 (6) ◽  
pp. 439-446 ◽  
Author(s):  
Gastón J. Piñeiro ◽  
Pilar Arrizabalaga ◽  
Manel Solé ◽  
Rosa M. Abellana ◽  
Gerard Espinosa ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Clinical Laboratory ◽  
Predictive Tool ◽  
Renal Flare ◽  
Therapeutic Decisions ◽  
The Mean ◽  
Mean Time

Background: How one responds to treatment of lupus nephritis (LN) is based on clinical features, but the activity in renal biopsy (RB) is uncertain. We have described the therapeutic decisions after performing a repeated RB on the assessment of response to intravenous cyclophosphamide (IC) and the possible prognostic role of this repeated RB. Methods: Clinical, laboratory and histological features at the initial RB and repeated RB were analyzed in 35 patients. Results: Data in the initial versus the repeated RB were serum creatinine 1.23 ± 1.08 and 0.96 ± 0.45 mg/dl (p < 0.05), glomerular filtration rate <60 ml/min in 12 and 5% patients and proteinuria 4.1 ± 2.8 vs. 0.6 1.1 g/day (p < 0.05). Significant differences were detected in hematuria, nephrotic syndrome and serological immune features. Complete renal remission was reached in 60% (n = 21) at the time of the repeated RB, partial remission in 31.4% (n = 11), and no response IC in 8.6% (n = 3). Nine patients showed proliferative forms in the repeated RB, 3 of them had proteinuria <1 g/day. Just after the repeated RB, 34.3% increased or started a new immunosuppressive therapy, 17.1% remained with the same complementary IST, and 14.3% decreased or stopped it. In the follow-up post repeated RB, 34.5% without active lesions showed a renal flare versus 77.8% with active lesions (p = 0.04). The mean time was 120 and 45 months, respectively. Conclusion: A repeated biopsy in LN distinguishes patients in true remission from those in apparent remission. By doing this, we can identify patients who could benefit from intensified treatment and for whom unnecessary treatment methods can be modified or eliminated.

Retrospective analysis of nephritis response and renal outcome in a cohort of 928 Egyptian lupus nephritis patients: a university hospital experience

Lupus ◽  
2017 ◽  
Vol 26 (14) ◽  
pp. 1564-1570 ◽  
Author(s):  
M Momtaz ◽  
A Fayed ◽  
M Wadie ◽  
S M Gamal ◽  
S A Ghoniem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Lupus Erythematosus ◽  
Interstitial Fibrosis ◽  
University Hospital ◽  
Response To Treatment ◽  
Renal Outcome ◽  
Induction Treatment ◽  
Baseline Serum

Aim We aim to describe the pattern of response to treatment in a cohort of Egyptian lupus nephritis (LN) patients and to define variable prognostic factors. Methods We retrospectively analyzed records of 928 systemic lupus erythematosus (SLE) patients (898 females, 30 males) with biopsy-confirmed LN seen between 2006 and 2012 at Cairo University hospitals. Results Our study involved 928 SLE patients with a mean age of 26.25 ± 6.487 years, mean LN duration at time of renal biopsy 6.48 ± 4.27 months, mean SLEDAI 28.22 ± 11.7, and mean follow-up duration of 44.14 ± 17.34 months. Induction treatment achieved remission in 683 patients. Remission was achieved in all 32 patients with class II LN, compared to 651/896 (72.7%) patients in classes III, IV, and V. Induction by intravenous (IV) cyclophosphamide achieved response in 435/575 (75.7%) patients, while induction by mycophenolate mofetil (MMF) resulted in response in 216/321 (67.3%) patients ( p = 0.0068). Nephritic flares were least observed when MMF was used for maintenance (30/239 (12.6%) patients), compared to 71/365 patients (19.5%) ( p = 0.0266) when azathioprine (AZA) was used, and 22/79 patients (27.8%) ( p = 0.002) with IV cyclophosphamide. Class IV LN, high chronicity index, presence of crescents, and interstitial fibrosis in biopsies were all associated with chronic kidney disease (CKD) development eventually ( p < 0.001, p = 0.005, p = 0.012, and p = 0.031, respectively). By the end of the study duration, 305 (32.7%) patients had CKD. Logistic regression detected that high baseline serum creatinine, failure to achieve remission, hypertension, and nephritic flare were the main risk factors for poor renal outcome ( p < 0.001, p < 0.001, p = 0.004, and p < 0.001, respectively). The 5 years’ mortality was 69 (7.4%) patients with sepsis being the main cause of death. Conclusion IV cyclophosphamide superseded as induction treatment, while MMF was the best maintenance treatment. High serum creatinine, hypertension, and nephritic flare were the main risk factors for poor renal outcome.

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