Alicia Marini

Lupus nephritis in Latin American patients: 10-year results from a single medical center in Argentina

Introduction Several studies have shown that Hispanic patients generally experience a worse renal prognosis than non-Hispanic white patients with lupus. To date, there is no report on American College of Rheumatology (ACR) renal response criteria (ACR-RRC) in patients from Latin America. Objective To evaluate treatment response in patients with proliferative and membranous lupus nephritis (LN) according to ACR-RRC. Methods A retrospective study (2001–2011) was performed in our hospital and the data collected included clinical information, renal assessment and immunological parameters. Details related to treatment received during induction and maintenance therapy were also recorded. Results The study included forty-three Latin American patients (37 women) from Argentina. Mean follow-up was 54 months. The regimen used for induction therapy included intravenous cyclophosphamide (IV-CYC) for six months in 36 patients and only seven received mycophenolate mofetil (MMF) given twice daily for a total dose of 2.5 ± 0.5 grams a day. For the maintenance period, six patients continued with quarterly IV-CYC, 20 patients received MMF (1.5 ± 0.5 grams a day) and 17 patients received azathioprine (AZA) 1.5 – 2 mg/kg/day. ACR-RRC observed after induction therapy was complete response in 19%, partial response in 9%, improvement in 42%, unchanged in 14%, and 16% had deterioration despite treatment. ACR-RRC observed after maintenance therapy was complete response in 30%, partial response in 23%, improvement in 19%, unchanged in 16%, and 12% had deterioration. Relapse was observed in 11 patients (25%). Ten out of 11 cases (91%) who relapsed did not achieve a complete response at the end of the induction therapy. Conclusion In Latin American patients from Argentina, only 19% could achieve a complete response after induction therapy and 30% achieved a complete response after maintenance therapy. Failing to obtain a complete response after induction therapy was related to an increased risk of relapse during long-term follow-up in our study.

FRI0287 Proliferative nephritis forms in sle patients with minimal proteinuria and high sledai

Background ACR and EULAR guidelines recommend performing renal biopsy in every SLE patient with proteinuria above 0,5g/24h. Some patients show an active urine analysis with dysmorphic erythrocytes but proteinuria < 0,5g/24h. Objectives To analyzed clinical manifestations, SLEDAI and histological classes found in patients with SLE and proteinuria <0,5g/24h without renal insufficiency Methods Retrospective study of 33 adult patients with SLE (ACR 1997) and proteinuria <0,5g/24h, were evaluated between 1995 and 2010 in the Division of Nephrology and Rheumatology at Clinical Hospital Jose San Martín. There were performed 192 biopsies, 35/192 (18%) had low proteinuria, but 2 were excluded due to renal insufficiency. We analyzed clinical manifestations and SLEDAI at the time of renal biopsy. All renal samples were studied by light microscopy and immunofluorescence and were classified according to the ISN RPS 2003. Data were analyzed using SPSS 17.0 program. Results There were 25 women (76%) and 8 men (24%), average age of 34 years (19-65) IQR 17. Median of disease: 120 months (36-264) IQR 96. Cutaneous involvement was found in 28 patients (84.8%), arthritis in 21 (63.6%), hematological features in 17 (51.5%), serositis in 9 (27.3%), and no patient had neurological criteria. Anti DNA was positive in 24 patients (72.7%) and hypocomplementemia 20 (60.6%). Mean SLEDAI was 15 (DS 6.06). Conclusions We found high prevalence of proliferative forms in SLE patients with low proteinuria (< 0,5g/24h). As mean SLEDAI was high in this cohort, patients frequently required moderate/high steroids doses. We hypothesized that the absence of mesangial forms and low proteinuria were probably related to this fact. These findings could suggest renal biopsy in lupus patients with glomerular hematuria and proteinuria < 0,5g/24h. SLEDAI is a tool that could be useful in the decision to perform renal biopsy. References George K Bertsias et al, Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis, Ann Rheum Dis 2012;71:1771–1782. Hahn BH et al, American College of Rheumatology guidelines for screening, treatment, and management of lupus nephritis, Arthritis Care Res 2012 Jun; 64(6):797-808. Sociedad Argentina de Reumatología y Sociedad Argentina de Nefrología, Primer Consenso Argentino sobre Diagnóstico y Tratamiento de la Nefropatía Lúpica, Rev Arg Reumatol. 2011; 22 (4): 06-37. Disclosure of Interest: None Declared