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

2019-10-01Journal article Open access
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dc.contributor.authorNavarro, D
dc.contributor.authorFerreira, AC
dc.contributor.authorViana, H
dc.contributor.authorCarvalho, F
dc.contributor.authorNolasco, F
dc.date.accessioned2019-10-25T10:18:18Z
dc.date.available2019-10-25T10:18:18Z
dc.date.issued2019-10-01
dc.description.abstractINTRODUCTION: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationActa Med Port. 2019 Oct 1;32(10):635-640.pt_PT
dc.identifier.doi10.20344/amp.11598pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3339
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherOrdem dos Médicospt_PT
dc.subjectHCC NEFpt_PT
dc.subjectBiopsypt_PT
dc.subjectAnalysis of Variancept_PT
dc.subjectComplement C3/metabolismpt_PT
dc.subjectGlomerular Filtration Ratept_PT
dc.subjectFollow-Up Studiespt_PT
dc.subjectPrognosispt_PT
dc.subjectImmunosuppressive Agents/therapeutic use
dc.subjectKidney/pathology
dc.subjectKidney/physiopathology
dc.subjectLupus Erythematosus, Systemic/complications
dc.subjectLupus Nephritis/classification
dc.subjectLupus Nephritis/pathology
dc.subjectLupus Nephritis/physiopathology
dc.subjectLupus Nephritis/therapy
dc.subjectProteinuria/diagnosis
dc.subjectProteinuria/epidemiology
dc.subjectRemission Induction
dc.subjectRetrospective Studies
dc.subjectTreatment Outcome
dc.titleMorphological Indexes: Can They Predict Lupus Nephritis Outcomes? A Retrospective Studypt_PT
dc.title.alternativeÍndices Morfológicos na Nefrite Lúpica: Orientação Prognóstica? Um Estudo Retrospectivopt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage640pt_PT
oaire.citation.issue10pt_PT
oaire.citation.startPage635pt_PT
oaire.citation.titleActa Médica Portuguesapt_PT
oaire.citation.volume32pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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