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Abstract: TH-PO662

Predictive Value of Chronic Histologic Changes in Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

  • Cuellar-Gutierrez, Maria C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Flores-Gouyonnet, Jaime, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Figueroa-Parra, Gabriel, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Casal Moura, Marta Isabel Rodrigues, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Crowson, Cynthia S., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Duarte-Garcia, Ali, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Sethi, Sanjeev, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

We aimed to assess the predictive value of the individual components of the NIH chronicity score and the Mayo Clinic Chronicity Score (MCCS) in lupus nephritis (LN).

Methods

LN patients from Mayo Clinic between 1992 and 2023 were included. The earliest kidney biopsy was index date. Follow-up was until July 2023, death or loss follow-up. Biopsy reports were reviewed by a nephropathologist (SS) and chronic lesions reclassified (glomerulosclerosis [GS], interstitial fibrosis [IF], tubular atrophy [TA], arteriosclerosis [AE], and fibrous crescents [FC]). The outcomes were proteinuria <500 mg/day and complete renal response (CRR) within 1-year, end-stage kidney disease (ESKD), and death. We used stratified multivariable proportional hazards regression adjusted for sex and age. P-values <0.05 were statistically significant.

Results

We included 307 patients (median age, 34 years; 75% female; median follow-up, 11 years). The majority had Class III, IV. FC were in 4.9%, AE in 12%.
At one year, 47.5% had proteinuria <500 mg/day and 43.4% CRR. Those with grade 2-3 of GS (HR 0.21 [0.09, 0.48] and grade 2-3 IFTA (HR 0.14 [0.05, 0.39] were less likely to achieve proteinuria <500 mg/day. Grade 2-3 of GS (HR 0.19 [0.08, 0.48]) and grade 2-3 IFTA (HR 0.16 [0.06, 0.44] were also less likely to achieve CRR.
Similarly, AE (HR 0.44 [0.21, 0.91], for proteinuria <500 mg/day, HR 0.37 [0.16, 0.84], for CRR) was associated with a reduced likelihood of achieving the outcomes.
During follow-up, 33 patients died, and 60 developed ESKD. No variables were associated with mortality. Grade 2-3 GS (HR 9.28 [4.91, 17.54], grade 2-3 IFTA (HR 20.10 [10.08, 40.08]), were associated with an increased ESKD (table).

Conclusion

GS, IFTA, AE are independently associated with outcomes in LN. FC is a rare finding. The MCCS included all the chronic histologic elements associated with outcomes in LN.