POS0741 HISTOPATHOLOGIC PATTERNS OF LUPUS NEPHRITIS PREDICT THE RISKS OF MORTALITY- A SINGLE-CENTER RETROSPECTIVE STUDY
Authors: Y. W. Liao, W. T. Hung, Y. M. Chen, C. W. Hsieh, T. Y. Hsieh, Y. H. Chen, W. N. Huang
Journal: Annals of the Rheumatic Diseases (2021)

Background: Lupus nephritis is a significant complication of systemic lupus erythematosus and is associated with increased risks of end-stage kidney disease and mortality. Objectives: The retrospective observational study aims to investigate which component of the National Institutes of Health activity and chronic indices of lupus nephritis can predict mortality. Methods: We identified 528 SLE patients with biopsy-proven lupus nephritis between 2006 and 2019. Two patients with class VI lupus nephritis were excluded, and a total of 526 patients were analyzed. Serum creatinine, urine protein-to-creatinine ratio (UPCR), and serologic markers for SLE disease activity were measured at the time of the renal biopsy. The histopathologic findings of renal biopsies were classified by utilizing the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification. Results: Among 526 patients enrolled, 64 expired, and 44 were female (68.8%, p=0.004). Class IV (± V) comprised the most (n= 39, 60.9%), followed by class V (n= 18, 29.7%). Lower eGFR was observed in the death group, compared with the survival group (median: 24.7 vs. 80.5, p&lt;0.001). There were no significant differences in UPCR and serologic markers for SLE (dsDNA, C3, and C4). Total scores of chronicity index and the scores for each index were higher in the death group. Interestingly, although total scores of activity index in death and survival groups did not differ significantly, the scores for cellular crescents tended to be higher in the death group (1.38 ±1.77 vs. 0.72 ±1.24, p=0.002) In the univariable analysis, age, male sex, eGFR, activity index scores, cellular crescents, chronicity index scores, and all CI components (global obsolete glomeruli, tubular atrophy, interstitial fibrosis, fibrous crescents) and tubulointerstitial nephritis were significantly associated with an increased risk of death. When patient characteristics and NIH activity/ chronicity indices were jointly examined in a multivariable analysis, fibrous crescents were significantly associated with increased risk of death in females (HR 5.23 [95% CI: 1.51, 18.09]) (Table 1). In males, the risks of death increased with cellular crescents (HR 1.73 [95% CI: 1.10, 2.73]) but decreased with global obsolete glomeruli (HR 0.12 [95% CI: 0.02, 0.91]). Conclusion: In this single-center observational study, fibrous crescents in females and cellular crescents in males were significantly associated with increased risks of mortality. References: [1]Doria A, Iaccarino L, Ghirardello A, et al. Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med 2006; 119: 700–706. [2]Faurschou M, Starklint H, Halberg P, Jacobsen S. Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure. J Rheumatol. 2006;33(8):1563-1569. [3]Chen YM, Hung WT, Liao YW, et al. Combination immunosuppressant therapy and lupus nephritis outcome: a hospital-based study. Lupus. 2019;28(5):658-666. Table 1. Logistic regression of predictors for mortality in patients with lupus nephritis Univariable Multivariable (Female) Multivariable (Male) HR 95% CI p value HR 95% CI p value HR 95% CI p value Age 1.03 (1.01-1.05) 0.002 1.02 (0.98-1.07) 0.267 1.01 (0.95-1.08) 0.670 Male sex 2.10 (1.23-3.55) 0.006 UPCR 1.02 (0.95-1.09) 0.616 eGFR 0.97 (0.96-0.99) &lt;0.001 0.99 (0.96-1.00) 0.183 0.98 (0.96-1.00) 0.086 Activity Index 1.06 (1.01-1.11) 0.027 Cellular crescents 1.29 (1.12-1.50) &lt;0.001 1.03 (0.63-1.67) 0.917 1.73 (1.10-2.73) 0.017 Chronicity Index 1.16 (1.07-1.26) &lt;0.001 global obsolete glomeruli 1.37 (1.08-1.76) 0.011 1.24 (0.55-2.77) 0.606 0.12 (0.02-0.91) 0.040 Tubular atrophy 1.65 (1.28-2.13) &lt;0.001 0.41 (0.06-2.82) 0.362 4.77 (0.30-75.32) 0.267 Interstitial fibrosis 1.71 (1.32-2.23) &lt;0.001 3.70 (0.52-26.24) 0.191 1.37 (0.07-27.40) 0.837 Fibrous crescents 2.38 (1.40-4.03) 0.001 5.23 (1.51-18.09) 0.009 0.00 (0-extremely large) 0.989 Tubulointerstitial nephritis 1.70 (1.03-2.80) 0.037 Disclosure of Interests: None declared