Development of an instrument to predict proliferative histological class in lupus nephritis based on clinical and laboratory data.

Autor: Silaide de Araújo Júnior A; Division of Rheumatology, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo, São Paulo, Brazil., Sato EI; Division of Rheumatology, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo, São Paulo, Brazil., Silva de Souza AW; Division of Rheumatology, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo, São Paulo, Brazil., Jennings F; Division of Rheumatology, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo, São Paulo, Brazil., Mastroianni Kirsztajn G; Division of Nephrology, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo, São Paulo, Brazil., Sesso R; Division of Nephrology, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo, São Paulo, Brazil., Dos Reis-Neto ET; Division of Rheumatology, Escola Paulista de Medicina, 28105Universidade Federal de São Paulo, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Lupus [Lupus] 2023 Feb; Vol. 32 (2), pp. 216-224. Date of Electronic Publication: 2022 Dec 02.
DOI: 10.1177/09612033221143933
Abstrakt: Objectives: To compare the correlations of histological class inferences based on clinical manifestations and laboratory tests between rheumatologists and nephrologists, to determine the associations of clinical and laboratory data with histological classes and to develop an instrument that can assist histological class identification in lupus nephritis (LN).
Methods: Retrospective study based on medical records of 80 systemic lupus erythematosus patients (SLICC criteria classification, 2012) who underwent kidney biopsy between 2010 and 2017. Two rheumatologists and two nephrologists received clinical and laboratory data and answered questions regarding which histological class was expected on kidney biopsy. Kappa (K) coefficient was used to assess agreement between evaluators. A decision tree was constructed using the chi-square interaction detector and logistic regression was performed for the development of the proliferative histological class predictor instrument .
Results: The mean age and disease duration were 33 ± 10.3 years and 11.5 ± 6.7 years, respectively. The level of agreement between the evaluators and kidney biopsy was poor (global K 0.364 ± 0.029; p < .001). Analyzing clinical and laboratory variables as predictors of proliferative histological class, patients with abnormal urinary sediment and positive anti-dsDNA antibodies presented 13.96 and 4.96 times higher risks of presenting class III or IV, respectively ( p < 0.001). Our instrument has a sensitivity of 87.8% and specificity of 80%, using abnormal urinary sediment, anti-dsDNA antibodies, and serum creatinine as variables.
Conclusions: Rheumatologists and nephrologists with experience in treating LN generated evaluations that correlated weakly with kidney biopsy. When kidney biopsy is unavailable or is contraindicated for medical reasons, instruments based on clinical and laboratory predictors may be helpful.
Databáze: MEDLINE
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