Clinical and Lab Parameters for Distinct Types of Lupus Nephritis: Proliferative and Non-Proliferative Classes

Abstract

Background and Objectives: Disease relapse and classes switching in lupus nephritis (LN) patients can occur during the follow up period. Kidney biopsy is the gold standard for definite diagnosis and determines the prognosis. However, it is not available in all centers. This study aimed to evaluate clinical and laboratory parameters that coned predict the proliferative classes in LN patients.

Methods:  We reviewed 68 patients who were diagnosed with LN. These patients had available medical data and native kidney biopsies were performed in Srinagarind hospital, a referral center for kidney biopsy in the Northeast of Thailand, during the period of Jan 2012 to May 2013. They were divided into two groups based on LN classes; 49 patients with proliferative class (LN class III, IV) and 19 patients with non-proliferative class. The clinical and laboratory parameters at the time of biopsy were compared between the both groups.

Results:  Of those 68 patients, the mean age was 33.6 + 12.6 years and the majority was female gender, 72 %. The LN class IV was the most frequent type, 67.6 %. By multivariable logistic regression, the 3 parameters were still significant and the adjusted ORs and 95% CI of this parameter were following: age ORs 0.94 (95%CI: 0.88-0.99); p = 0.03, eGFR less than 60 ml/min/1.73m² ORs 5.56 (95%CI: 1.05-29.5); p = 0.04 and > 10 urinary RBC/hpf ORs 6.54 (95%CI: 1.49-28.75); p = 0.01, respectively. In addition to 3 parameters, we found that positive of anti-dsDNA was only positive in proliferative LN group.

Conclusion: This study demonstrated young age onset of LN, reduction of glomerular filtration less than 60 ml/min/1.73m² and > 10 of urinary RBC/hpf are predictors of proliferative LN that may be used  in clinical practice to classified LN classes and make a decision of treatment.