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Abstract
Background Kidney biopsies provide useful information to guide management in lupus nephritis (LN). Standard histopathology report includes ISN/RPS class, as well as Activity Index (AI) and Chronicity Index (CI) scores representing inflammation and fibrosis, respectively. We analyzed the clinical attributes associated with histopathologic class, AI and CI scores in patients with LN.
Methods We reviewed the medical records of LN patients seen at the University of Santo Tomas (UST, Manila Philippines) who underwent kidney biopsies from 2015 to 2022. Correlations between SLE disease characteristics at time of biopsy with ISN/RPS class, AI and CI scores were analyzed using Pearson correlation coefficient.
Results Of 44 patients (95.5% females), 13 and 29 patients had Class III and Class IV LN respectively, 1 each with co-existing Class V. Two patients had pure Class V, there were no patients in the other classes. Mean age was 25.1±10.3 years at LN diagnosis, with average disease duration of 2.4±3.7 years from diagnosis to biopsy. 70.5% had mild to moderate disease (SLEDAI<12) at biopsy. Average serum creatinine was 1.4±0.87 mg/dL, eGFR 71.8±37.7 mL/min, UPCR 2.6±1.4, and SLEDAI 10.6±4.4. Of renal parameters, only hypertension was associated with higher CI (r=0.417,p=0.002); although there was a trend for higher UPCR (r=0.144,p=0.176) and serum creatinine (r=0.221,p=0.075) correlating with higher AI, this was not statistically significant. Extra-renal features of oral ulcers (r=-0.368,p=0.007), arthritis (r=-0.461,p=0.001), and serositis (r=-0.301,p=0.023) were associated with lower CI scores. There was no correlation of individual disease parameters with ISN/RPS class.
Conclusions This study demonstrated a significant correlation of hypertension with higher chronicity index scores among LN patients. Extra-renal disease activity features of oral ulcers, arthritis and serositis had lower CI scores. Aside from early aggressive management of active LN, strict sustained blood pressure control must be reinforced throughout the disease course in order to prevent renal damage.
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