FRI0164 BANFF INFLAMMATORY INDICES MAY BE SUPERIOR TO THE NIH SCORING IN PREDICTING CKD PROGRESSION IN LUPUS NEPHRITIS
Authors: M. D. Duong, D. Schwartz, S. Wang, A. R. Broder, B. Goilav
Journal: Annals of the Rheumatic Diseases (2020)

Background: Chronic kidney disease/end stage renal disease (CKD/ESRD) from lupus nephritis (LN) is a major cause of morbidity and mortality. Advanced tubulointerstitial disease (TID) in LN is a better predicor of renal outcome than glomerular lesions. The current NIH classification is heavily weighted towards glomerular lesions and only provides a semiqualitative assessment of TID. In contrast, Banff classification of renal allograft pathology provides 6 reproducible scores for TID (inflammation, fibrosis, atrophy). Banff scoring may better predict CKD/ESRD in LN than NIH scores Objectives: We compared Banff grading vs. NIH scoring as predictors of CKD progression at 5 years, defined as a decline in estimated glomerular filtration rate (eGFR) ≥30%, a strong risk factor for ESRD and mortality Methods: We included patients with LN class III, IV, V on the index biopsy Jan 2005 and Dec 2018. H&amp;E/PAS stained slides were reviewed and scored by an experienced pathologist. Six TID Banff scores (0/1 vs. 2/3), NIH activity/chronicity (AI/CI) and NIH interstitial fibrosis/tubular atrophy (IF/TA), tubulointerstitial inflammation (TII) scores (none/mild vs. moderate/severe) were evaluated as predictors of CKD progression using survival analyses Results: Of the 125 patients, 46 had CKD progression and 20 subsequently developed ESRD. There were no differences between progressors and non-progressors in terms of baseline demographic, clinical data, LN class (Tab 1). Banff ti score (total inflammation) was associated with CKD progression in bivariate and time-dependent analyses. However, NIH TII score and corresponding Banff i score were not predictive (Tab 2, Fig 1). Overall NIH AI and CI were not predictive of CKD progression. Moderate/severe NIH IF/TA was associated with CKD progression as was Banff ci (interstitial fibrosis) score (Tab 2, Fig 2). Banff score for atrophy was not predictive. In a subset of 92 patients with baseline eGFR≥60ml/min/1.73m 2 only Banff ti score (but not i score or NIH TII, IF/TA) was predictive of CKD progression (Fig 1) Table 1. Baseline data in patients with/without CKD progression Progressors 1 n=46 Non-progressors n=79 p n (%) or median (IQR) Female 36 (78) 69 (87) 0.18 Age (years) 26 (20-41) 29 (21-43) 0.53 &lt;18 years 7 (15) 13 (16) 0.86 Race 0.82 White 4 (9) 4 (5) Black 18 (39) 35 (44) Asian 1 (2) 1 (1) Unknown 23 (50) 39 (50) Diabetes 5 (11) 3 (4) 0.12 Hypertension 33 (72) 55 (70) 0.8 eGFR ml/min/1.73m 2 96.1 (56.6-117.8) 88.9 (47-117) 0.51 C3 mg/dL 71 (52-88) 67.5 (43-94) 0.58 C4 mg/dL 12.65 (9-23) 12 (7-20) 0.48 Anti-ds DNA titer IU 108.7 (36.6-194.9) 151.3 (39.2-200) 0.57 Total SLEDAI 11 (8-16) 12 (8-16) 0.47 Renal SLEDAI 8 (4-12) 8 (4-12) 0.9 LN Proliferative GN 2 : III, IV 18 (39) 30 (38) 0.15 Nonproliferative GN: V 9 (20) 27 (34) Mixed GN: V and III/IV 19 (41) 22 (28) 1 Progressors: LN patients with eGFR decline ≥30% within 5 years. 2 GN: glomerulonephritis Table 2. NIH and Banff scores with/without progressors Progressors n=46 Non-progressors n=79 p n (%) or median (IQR) NIH Overall AI 1 (0-4) 1 (0-3) 0.61 AI ≥ 11 1 (2) 3 (3.8) 0.62 Overall CI 3 (0-5) 2 (0-3) 0.33 CI ≥ 3 24 (52) 28 (35.4) 0.07 Moderate/severe TII 7 (15.2) 4 (5) 0.05 Moderate/severe IF/TA 16 (35) 15 (19) 0.049 Banff Tubulitis: t 0 0 Interstitial inflammation: i 2/3 3 (6.5) 5 (6.3) 0.9 Total inflammation: ti 2/3 16 (34.8) 12 (15.2) 0.01 Tubular atrophy: ct 2/3 16 (34.8) 16 (20.3) 0.07 Interstitial fibrosis: ci 2/3 17 (37) 15 (19) 0.03 Inflammation in area of interstitial fibrosis and/or tubular atrophy: i-IFTA 2/3 n=26* 18 (69) n=51* 25 (49) 0.09 * Biopsy number is smaller due to inability to apply score to biopsies without areas of fibrosis/tubular atrophy Conclusion: Banff inflammation scores may be superior predictors of CKD/ESRD progression at 5 years, compared to the currently used NIH classification. Detection of inflammation by Banff scores may allow earlier interventions to prevent ESRD Disclosure of Interests: None declared