Pediatric Rheumatology Online Journal →
July 2003 →
Childhood Lupus→ Clinical
Presentation, course and Outcomes →
Abstract #92
WHO CLASSIFICATION OF LUPUS NEPHRITIS: CORRELATION WITH DISEASE ACTIVITY AND RENAL OUTCOME IN CHILDREN
M. Zappitelli,1 I. Gupta,1,2 C. M. Bernard,1,2 R. Scuccimarri,1,2 K. N. Duffy,1,2 C. M. Duffy.1,2
1Rheumatology, Montreal Children's Hospital, Montreal, Canada; 2McGill University, Montreal, Canada
Background: Controversy exists regarding the classification of renal biopsies in lupus nephritis. We studied our pediatric lupus population retrospectively to determine 1) if clinical and laboratory data correlated with WHO renal biopsy classification at initial diagnosis and at follow-up; and 2) if WHO renal biopsy classification at disease onset was predictive of renal outcome. Methods: Clinical and laboratory data were recorded at each biopsy and included complete blood count, serum albumin, serum creatinine, serum complement, DNA binding activity, 24-hour urine protein, urinalysis, glomerular filtration rate, and need for blood pressure (BP) medications. Renal outcomes evaluated at 1, 2, 3, and 5 year follow-up from initial biopsy included: 1) creatinine 80umol/L; 2) GFR 120 mls/min/1.73m; 3) change in creatinine of 30umol/L; 4) 24 hour urine protein 100 mg/m/day; 5) need for BP medications. Analysis: Spearman correlation and Chi-square tests with Bonferroni correction. Results: Five male and 20 female patients with mean age at disease onset 12.8 +/- 2.67 years (range 8 to 17) underwent an initial biopsy. Sixteen patients had a second biopsy. At first biopsy, 24-hour urine protein (rho = 0.867,p0.001), hematuria (rho = 0.884,p0.001), serum albumin (rho =-0.593,p0.003) and need for BP medication (p0.007) correlated with worse class of lupus nephritis. At biopsy 2, there were no significant correlations between any of the parameters and biopsy classification. Initial biopsy classification did not predict worse outcome at 1, 2, 3 or 5 year follow-up. Conclusion: Proteinuria, hematuria, low serum albumin and hypertension predicted worse class of lupus nephritis at initial biopsy. At follow-up biopsy, laboratory and clinical parameters did not predict WHO class of lupus nephritis. WHO class on initial biopsy did not predict renal outcome. New indices for grading lupus nephritis are available and their effectiveness is currently being evaluated in this cohort.