Estudo retrospectivo de 240 biópsias de Nefrite Lúpica, avaliando doença renal dialítica e morte como desfechos

• Ano de defesa: 2016
• Autor(a) principal: Vila-Inda, Catarina Juliana [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: lupus nephritis; Histology; Outcomes; Nefrite lúpica; Histologia; Desfechos
• Link de acesso: https://repositorio.unifesp.br/handle/11600/47213

Background/Purpose: Lupus nephritis (LN) affects up to 60% of SLE patients and is worse in minority communities. Traditionally proliferative LN is clinically more severe and confers worse outcomes. However, a significant number of patients with membranous and mixed LN do develop renal failure. To evaluate what factors can possibly be associated to the development of end stage renal disease (ESRD) and/or death, and to identify whether class on biopsy can be associated to ESRD and/or death we studied a cohort of African Americans and Hispanics with LN in a large academic center in New York/USA. Methods: All renal biopsies from January 1997-December 2011 were analyzed. 199 patients with ?4/11 ACR SLE criteria and biopsy proven LN classes III±V, IV±V and V were selected. Patients with a second biopsy, regardless of class type, were also selected. Baseline demographic, laboratory information, and treatment regimens were collected at the time of biopsy, 6 and 12 months after. Demographic and clinical characteristics underwent bivariate analysis. A multivariate analysis was applied on variables of interest. Kaplan-Meier curves were used to analyze the risk of developing ESRD or death based on class. Results: Of the total of 199 subjects included, 82.5% were female at median age of 33y, predominantly Black and Hispanic (47.5% and 42.5%, respectively). 120 (60.5%) had Proliferative LN (Class III or IV, P), 54 (27%) had Membranous LN (Class V, M), and 25 (12,5%) had Mixed disease (P+M) on first biopsy. Black patients were more likely to have class V (73.5%) as compared to Hispanics (24.5%). No correlations were found among groups considering age, gender or disease duration. Proliferative LN showed higher creatinine (p<0.01) and lower Glomerular Filtration Rate (GFR) (p<0.001); but there was no difference between M or P+M on both parameters. Proliferative LN also had significantly higher urine white blood cells (p<0.001) and lower Complement C3 (p<0.001) and C4 (p=0.03). Increased dsDNA was found in both P and M lesions (p<0.001) as well as median blood pressure (BP) (p=0.001). There was no difference in median protein/creatinine ratios and serum albumin among groups. Both ESRD and survival estimates were significantly worse for Proliferative LN (p=0.003 and p=0.01, respectively). Class (p<0.002), and factors related to the disease severity, specifically GFR (p<0.001), serum creatinine (p<0.001), and protein/creatinine ratio (p=0.01), were significantly associated with the risk of developing ESRD over time and with death. The development of ESRD (p=0.002) was solely associated with death. Forty-one patients (21%) underwent a second biopsy. Repeat biopsy appears significantly (p=0.04) associated with ESDR. Conclusion: In this specific SLE population, class was an independent factor of association with death and/or ESRD. It is most likely that the disease severity itself is what drives the prognosis. GFR and protein to creatinine ratio are associated with ESRD. Age, GFR and ESRD are associated with death. Repeat biopsy was found to be associated with less mortality. Further studies looking into early attention with patients presenting more aggressive renal disease and differences among races would be important in both treatment and DRD and/or death as outcomes in lupus patients.