Worse renal outcome of subclass IV-G lupus nephritis patients over IV-S
Carregando...
Citações na Scopus
2
Tipo de produção
article
Data de publicação
2018
Título da Revista
ISSN da Revista
Título do Volume
Editora
SAGE PUBLICATIONS LTD
Citação
LUPUS, v.27, n.4, p.584-590, 2018
Resumo
Background International Society of Nephrology/ Renal Pathology Society (ISN/RPS) consensus on the classification of lupus nephritis (LN) subdivided class IV into diffuse segmental (IV-S) and diffuse global (IV-G). Nephrologists and nephropathologists believe that this subclassification would be clinically relevant based on hypothetical distinct immunopathogenesis of those subclasses guiding therapy as well as judging prognosis. Methods All adult patients with a renal biopsy-confirmed diagnosis of LN class IV undergoing regular follow-up in the Nephrology Division between January 2004 and December 2014 were enrolled excluding those with diabetes, hepatitis B, hepatitis C, HIV as well as those with insufficient clinical and hystopathological data. Biopsies were reviewed and reclassified according to ISN/RPS 2003 classification by two experienced pathologists and were examined by light microscopy and direct immunofluorescence. Results On baseline subclass IV-G compared to IV-S showed higher frequency of males and histologically higher activity (7.52.8 vs 5.1 +/- 2.3, p=0.004) and chronicity index (3.4 +/- 1.6 vs 2.4 +/- 1.8, p=0.016) as well as a higher percentage of epithelial crescents (12.9 vs 5.1, p=0.0001) and vessel abnormalities (72% vs 42%, p=0.017). Although renal function on baseline was not different between subclasses, IV-G showed lower levels, although not significant, of estimated glomerular filtration based on CKD-EPI formula (91.0 +/- 34.8 vs 64.4 +/- 44.5, p=0.059) at the end of follow-up. In addition, we observed a higher rate of patients reaching CKD-EPI under 60mL/min/1.73m(2) in subclass IV-G over IV-S on last follow-up. Conclusion Subclasses IV-S and IV-G patients show some clinical and pathological differences that might represent distinct stages of the same disease and they should thus be treated the same.
Palavras-chave
Renal lupus, systemic lupus erythematosus, nephritis
Referências
- Alaiya A, 2015, NEPHROL DIAL TRANSPL, V30, P62, DOI 10.1093/ndt/gfu215
- AUSTIN HA, 1984, KIDNEY INT, V25, P689, DOI 10.1038/ki.1984.75
- Buhaescu I, 2007, SEMIN ARTHRITIS RHEU, V36, P224, DOI 10.1016/j.semarthrit.2006.09.002
- Colares VS, 2014, PLOS ONE, V9, DOI 10.1371/journal.pone.0087716
- Gao JJ, 2012, RHEUMATOL INT, V32, P1751, DOI 10.1007/s00296-011-1899-6
- Haring CM, 2012, J AM SOC NEPHROL, V23, P149, DOI 10.1681/ASN.2011060558
- Hill GS, 2005, KIDNEY INT, V68, P2288, DOI 10.1111/j.1523-1755.2005.00688.x
- LEVEY AS, 1992, ANN INTERN MED, V116, P114, DOI 10.7326/0003-4819-116-2-114
- Markowitz GS, 2009, CURR OPIN NEPHROL HY, V18, P220, DOI 10.1097/MNH.0b013e328327b379
- Mittal B, 2004, AM J KIDNEY DIS, V44, P1050, DOI 10.1053/j.ajkd.2004.08.027
- Najafi CC, 2001, KIDNEY INT, V59, P2156, DOI 10.1046/j.1523-1755.2001.0590062156.x
- TAN EM, 1982, ARTHRITIS RHEUM, V25, P1271, DOI 10.1002/art.1780251101
- Vandepapeliere J, 2014, LUPUS, V23, P159, DOI 10.1177/0961203313514623
- Weening JJ, 2004, KIDNEY INT, V65, P521, DOI 10.1111/j.1523-1755.2004.00443.x
- Wilhelmus S, 2015, J AM SOC NEPHROL, V26, P2938, DOI 10.1681/ASN.2015040384
- Wu CT, 2003, PEDIATR NEPHROL, V18, P1304, DOI 10.1007/s00467-003-1266-2
- Xu SC, 2014, CLIN NEPHROL, V81, P411, DOI 10.5414/CN108191
- Yokoyama H, 2004, KIDNEY INT, V66, P2382, DOI 10.1111/j.1523-1755.2004.66027.x
- Yu F, 2009, LUPUS, V18, P1073, DOI 10.1177/0961203309106795