Contribution of renal biopsy data in predicting outcome in lupus nephritis: analysis of 116 patients

Abstract

We reassessed renal biopsy specimens from 116 patients with systemic lupus erythematosus and clinical manifestations of lupus nephritis to determine the contributions of the World Health Organization classification system, the activity and chronicity indexes of the National Institutes of Health scoring system, and various clinical parameters at the time of biopsy to predicting disease outcome. Multivariate analysis showed that only a chronicity index >3 was predictive for decreased renal survival, while age >31 years at biopsy and a chronicity index >3 were associated with decreased patient survival. Clinical tests of renal function were not reliable in discriminating between active lesions and chronic renal damage.Despite recent impressive improvements in patient survival compared with the presteroid era, renal disease secondary to systemic lupus erythematosus (SLE) is still associated with high morbidity and mortality rates (14). At present, uncertainty still exists about the prognostic value of various parameters in lupus nephritis, but recent cumulative evidence indicates that the presence of the following parameters at biopsy is associated with increased risk for renal failure: young age (<23 years), increased serum creatinine levels, diffuse proliferative lesions (World Health Organization [WHO] class IV), and a high chronicity index on renal histologic analysis (4-10).In this study, we analyzed 116 SLE patients with clinical evidence of lupus nephritis to determine the contribution of various factors to their prognosis and, in particular, the merits of evaluating renal histology in these patients. We also examined possible correlations between clinical and histologic data at the time of renal biopsy to see if the biopsy findings could have been predicted by simple clinical data determined at the time of biopsy. PATIENTS AND METHODSPatients. In order to obtain an adequate study population, all 8 university hospitals and major teaching hospitals treating patients with SLE in The Netherlands were asked to cooperate in this study. Nearly 20% of those contacted declined cooperation for various reasons (disagreement with study protocol, insufficient time). The remaining 80% of clinicians agreed to provide data and renal biopsy specimens from all their patients with lupus nephritis who had undergone biopsy. We obtained 152 renal biopsies, 10 of which were repeat biopsies and were therefore not included in our analysis; another 26 samples had to be excluded for various reasons (14 due to insufficient material [less than 6 glomeruli], 9 because the diagnosis of SLE did not meet the American Rheumatism Association [ A M ] criteria [ 11.121, and 3 because postbiopsy followup, before an end-point of either death or renal dialysis was reached. was <I2 months).

LUPUS NEPHRITIS- A STUDY ON CLINICAL & HISTOMORPHOLOGICAL VARIABLES IN RELATION TO PROGNOSIS, IN NORTH KERALA

“…12,[17][18][19] Of these the Chronicity index and its components have been more consistently found to correlate with long term prognosis. 20 In our study Chronicity indices and two of its componentstubular dilatation and interstitial fibrosis were found to be significant.…”

Lupus Nephritis-a Critical Analysis of 17 Patients

“…Histological lesions may not always correlate well with the clinical severity, hence kidney biopsy should be performed in every patient with clinicalllaboratory evidence of renal involvement [8][9][10]. We found class III/class IV lesions in 88.22% of the cases.…”

Glomerulonefrite lúpica: estudo da evolução a longo prazo

“…A prevalência das diferentes classes de nefropatia é muito variável de centro para centro 11,[15][16][17][18][19][20][21][22] , não se sabendo se esta diferença reflete maior gravidade da nefropatia de uma região para outra, ou é decorrente de diferença de amostra- gem. Na casuística estudada, a nefropatia classe IV foi a mais freqüente (80%), como o descrito por Nossent et al 15 , diferindo no entanto dos dados obtidos em nosso meio por Acioli et al 22 , que estudando pacientes submetidos à biópsia ou autópsia, observaram que a prevalência das classes III (35%) e IV (39%), foi semelhante. Grande parte dos pacientes com alterações renais importantes apresentaram regressão desses sintomas, sendo que 50% dos pacientes com insuficiência renal inicial apresentaram melhora de função; remissão da síndrome nefrótica ocorreu em 2/3 dos pacientes.…”

“…Outros fatores estudados como sexo, idade, proteinúria e presença de hipertensão arterial à época da bió-psia mostraram não ter valor prognóstico. A importância desses fatores como indicador prognós-tico ainda é discutível 10,[13][14][15]19,21,[24][25][26] . A sobrevida observada no presente trabalho (5 anos = 82%; 10 anos = 70%) é semelhante à observada nos países desenvolvidos onde varia entre 76 e 89% em 5 anos e entre 56 e 78% em 10 anos 8,10,14,15,19 .…”

“…Estudos recentes têm relatado que a doença cardiovascular está se tornando importante causa de óbito 14,15 . Em países em desenvolvimento é possível que os pacientes com glomerulonefrite lúpica apresentem pior prognóstico devido a associação de infecção, baixos níveis sócio-econômicos e baixa escolaridade, usualmente encontrados nesses países.…”