PT - JOURNAL ARTICLE AU - A Gopal AU - C Kavadichanda AU - D Bairwa AU - S Shah AU - S Bh AU - S Mehra AU - M Thabah AU - V Negi TI - PO.5.108 Combined model of renal histopathology and clinical parameters better predicts one-year renal outcomes in lupus nephritis: analysis of 334 kidney biopsies AID - 10.1136/lupus-2022-elm2022.131 DP - 2022 Oct 01 TA - Lupus Science & Medicine PG - A84--A85 VI - 9 IP - Suppl 2 4099 - http://lupus.bmj.com/content/9/Suppl_2/A84.2.short 4100 - http://lupus.bmj.com/content/9/Suppl_2/A84.2.full SO - Lupus Sci Med2022 Oct 01; 9 AB - Background/Purpose Diagnosis of Lupus Nephritis (LN) is currently based on laboratory tests and renal histopathology. The role of histopathological features in determining long term outcomes is unclear. The objectives are to determine if clinical and biochemical parameters at baseline could identify renal histopathological class and to assess the clinico-histopathological predictors of renal response.Methods This is a single centre retrospective study comprising 334 LN renal biopsies. Clinical and biochemical parameters at the time of biopsy were noted and their association with histopathological class, activity and chronicity scores (AS/CS) (ISN/RPS classification) were evaluated. Complete, partial or no response(CR, PR, NR) for the renal outcome (EULAR/EDTA) at 1 year were calculated for 293 patients. Binary logistic regression was done to look for the predictors of NR.Results Class III/IV LN was seen in 240(71.8%). Hypertension was seen in (52.1%) of class III/IV and <25% each with class II, V and combined class(p<0.001). Class III/IV had lower eGFR [87.6(62.75–118.8)] (p<0.001) than the other classes. Nephrotic range proteinuria was seen in 32% of class V and 21% in class III/IV (p=0.004) Among class-III/IV AS had weak correlation with baseline UPCR (r=0.31) and eGFR (r=-0.172) (p<0.01). CS had weak negative correlation with eGFR (r=-0.212,p<0.01). NR at 1 year was higher in males (OR-4.6,95%CI-1.9–10.8,p<0.001), those with abnormal serum creatinine (OR-3.3,95%:CI1.6–7.02, p-0.001), higher renal SLEDAI (p<0.05), higher AS, CS (p<0.001), interstitial inflammation and tubular atrophy(p<0.005) (Table-1). On binary logistic regression a combined clinico-histopathological model comprising of serum creatinine, UPCR, male sex and CS performed best in predicting NR (figure 1).View this table:Abstract PO.5.108 Table 1 Comparison of baseline characteristics among those who attained any response (CR/PR) versus others at one yearAbstract PO.5.108 Figure 1 ROC curve and AUC for the three different modelsModel 1: Baseline serum creatinine, urine PCR, male sex; AUC −0.694(0.609–0.779), p <0.001Model 2: Baseline serum creatinine, urine PCR, male sex, chronicity score; AUC −0.740(0.660–0.820), p<0.00lModel 3: Baseline serum creatinine, urine PCR, male sex, chronicitv score, crescents, interstitial inflammation;AUC −0.744(0.664–0.824), p<0.00lAUC, Area Under Curve; ROC, Receiver-Operating CharacteristicsConclusion Clinical and biochemical parameters can predict the renal histological class to a fair extent but have limited value in predicting the activity and chronicity parameters. Since a combination of clinical and histopathology parameters are better in predicting renal outcomes, performing renal biopsies should be encouraged in LN.