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Evaluation of activity, chronicity and tubulointerstitial indices for childhood lupus nephritis

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Abstract

Few data exist on use of the National Institutes of Health (NIH) activity index (AI) and chronicity index (CI) in childhood lupus nephritis (LN). A tubulointerstitial activity index (TIAI) has been derived but not validated. We evaluated clinicopathologic correlations of the AI, CI and TIAI in children with LN who had undergone initial renal biopsy (n = 25, age 12.4 ± 2.7 years, biopsy 1) and 1 year after treatment (n = 15, biopsy 2). The TIAI correlated with the AI at biopsy 1 (r = 0.76, P = 0.001) and biopsy 2 (r = 0.52, P = 0.05), but not with CI scores. Mean AI and CI scores changed substantially from biopsy 1 to biopsy 2 (P < 0.05), but TIAI scores did not. Higher AI and TIAI scores correlated with proteinuria at both biopsies (r = 0.51–0.76, P < 0.05); CI scores correlated with estimated creatinine clearance (r = 0.46–0.58, P < 0.05). Improved AI score from biopsy 1 to biopsy 2 was associated with decrease in proteinuria. These results suggest that the AI and CI are useful in childhood LN. The TIAI may be a valid measure to evaluate the tubulointerstitium, but research is needed to define its responsiveness to change with therapy.

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References

  1. Perfumo F, Martini A (2005) Lupus nephritis in children. Lupus 14:83–88

    Article  CAS  PubMed  Google Scholar 

  2. Gloor JM (1998) Lupus nephritis in children. Lupus 7:639–643

    Article  CAS  PubMed  Google Scholar 

  3. Mittal B, Rennke H, Singh AK (2005) The role of kidney biopsy in the management of lupus nephritis. Curr Opin Nephrol Hypertens 14:1–8

    Article  PubMed  Google Scholar 

  4. Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 65:521–530

    Article  PubMed  Google Scholar 

  5. Churg J, Bernstein J, Glassock RJ (eds) (1995) Renal disease: classification and atlas of glomerular disease, 2 edn. Igaku-Shoin, New York, Tokyo, pp 151–156

  6. Faurschou M, Starklint H, Halberg P, Jacobsen S (2006) Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure. J Rheumatol 33:1563–1569

    PubMed  Google Scholar 

  7. Hunter MG, Hurwitz S, Bellamy CO, Duffield JS (2005) Quantitative morphometry of lupus nephritis: the significance of collagen, tubular space, and inflammatory infiltrate. Kidney Int 67:94–102

    Article  PubMed  Google Scholar 

  8. Daniel L, Sichez H, Giorgi R, Dussol B, Figarella-Branger D, Pellissier JF, Berland Y (2001) Tubular lesions and tubular cell adhesion molecules for the prognosis of lupus nephritis. Kidney Int 60:2215–2221

    Article  CAS  PubMed  Google Scholar 

  9. Hill GS, Delahousse M, Nochy D, Tomkiewicz E, Rémy P, Mignon F, Méry JP (2000) A new morphologic index for the evaluation of renal biopsies in lupus nephritis. Kidney Int 58:1160–1173

    Article  CAS  PubMed  Google Scholar 

  10. Austin HA 3rd, Muenz LR, Joyce KM, Antonovych TA, Kullick ME, Klippel JH, Decker JL, Balow JE (1983) Prognostic factors in lupus nephritis. Contribution of renal histologic data. Am J Med 75:382–391

    Article  PubMed  Google Scholar 

  11. McCurdy DK, Lehman TJ, Bernstein B, Hanson V, King KK, Nadorra R, Landing BH (1992) Lupus nephritis: prognostic factors in children. Pediatrics 89:240–246

    CAS  PubMed  Google Scholar 

  12. Rush PJ, Baumal R, Shore A, Balfe JW, Schreiber M (1986) Correlation of renal histology with outcome in children with lupus nephritis. Kidney Int 29:1066–1071

    Article  CAS  PubMed  Google Scholar 

  13. Sumboonnanonda A, Vongjirad A, Suntornpoch V, Laohapand T, Parichatikanond P (1998) Renal pathology and long-term outcome in childhood SLE. J Med Assoc Thai 81:830–834

    CAS  PubMed  Google Scholar 

  14. Tanaka H, Tateyama T, Waga S (2001) Methylprednisolone pulse therapy in Japanese children with severe lupus nephritis. Pediatr Nephrol 16:817–819

    Article  CAS  PubMed  Google Scholar 

  15. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277

    Article  CAS  PubMed  Google Scholar 

  16. Zappitelli M, Duffy C, Bernard C, Scuccimarri R, Watanabe Duffy K, Kagan R, Gupta IR (2004) Clinicopathological study of the WHO classification in childhood lupus nephritis. Pediatr Nephrol 19:503–510

    Article  PubMed  Google Scholar 

  17. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  PubMed  Google Scholar 

  18. Zappitelli M, Joseph L, Gupta IR, Bell L, Paradis G (2007) Validation of child serum creatinine-based prediction equations for glomerular filtration rate. Pediatr Nephrol 22:272–281

    Article  PubMed  Google Scholar 

  19. Banfi G, Mazzucco G, Barbiano di Belgiojoso G, Bestetti Bosisio M, Stratta P, Confalonieri R, Ferrario F, Imbasciati E, Monga G (1985) Morphological parameters in lupus nephritis: their relevance for classification and relationship with clinical and histological findings and outcome. Q J Med 55:153–168

    CAS  PubMed  Google Scholar 

  20. Esdaile JM, Joseph L, MacKenzie T, Kashgarian M, Hayslett JP (1993) The pathogenesis and prognosis of lupus nephritis: information from repeat renal biopsy. Semin Arthritis Rheum 23:135–148

    Article  CAS  PubMed  Google Scholar 

  21. Schwartz MM, Lan SP, Bernstein J, Hill GS, Holley K, Lewis EJ (1992) Role of pathology indices in the management of severe lupus glomerulonephritis. Lupus Nephritis Collaborative Study Group. Kidney Int 42:743–748

    Article  CAS  PubMed  Google Scholar 

  22. Fujinaga S, Kaneko K, Ohtomo Y, Murakami H, Takada M, Akashi S, Hira M, Yamashiro Y (2005) Induction therapy with low-dose intravenous cyclophosphamide, oral mizoribine, and steroids for severe lupus nephritis in children. Pediatr Nephrol 20:1500–1503

    Article  PubMed  Google Scholar 

  23. Singh S, Devidayal, Minz R, Nada R, Joshi K (2006) Childhood lupus nephritis: 12 years experience from North India. Rheumatol Int 26:604–607

    Article  PubMed  Google Scholar 

  24. Brunner HI, Mueller M, Rutherford C, Passo MH, Witte D, Grom A, Mishra J, Devarajan P (2006) Urinary neutrophil gelatinase-associated lipocalin as a biomarker of nephritis in childhood-onset systemic lupus erythematosus. Arthritis Rheum 54:2577–2584

    Article  CAS  PubMed  Google Scholar 

  25. Adams A, MacDermott EJ, Lehman TJ (2006) Pharmacotherapy of lupus nephritis in children: a recommended treatment approach. Drugs 66:1191–1207

    Article  CAS  PubMed  Google Scholar 

  26. Marks SD, Shah V, Pilkington C, Woo P, Dillon MJ (2005) Renal tubular dysfunction in children with systemic lupus erythematosus. Pediatr Nephrol 20:141–148

    Article  PubMed  Google Scholar 

  27. Chien JW, Chen WL, Tsui YG, Lee MC, Lin AY, Lin CY (2006) Daily urinary interleukin-11 excretion correlated with proteinuria in IgA nephropathy and lupus nephritis. Pediatr Nephrol 21:490–496

    Article  PubMed  Google Scholar 

  28. Deekajorndech T (2005) Fractional excretion magnesium (FE Mg) in systemic lupus erythematosus. J Med Assoc Thai 88:743–745

    PubMed  Google Scholar 

  29. Hataya H, Ikeda M, Ide Y, Kobayashi Y, Kuramochi S, Awazu M (1999) Distal tubular dysfunction in lupus nephritis of childhood and adolescence. Pediatr Nephrol 13:846–849

    Article  CAS  PubMed  Google Scholar 

  30. Gamba G, Reyes E, Angeles A, Quintanilla L, Calva J, Peña JC (1999) Observer agreement in the scoring of the activity and chronicity indexes of lupus nephritis. Nephron 57:75–77

    Article  Google Scholar 

  31. Schwartz MM, Lan SP, Bernstein J, Hill GS, Holley K, Lewis EJ (1993) Irreproducibility of the activity and chronicity indices limits their utility in the management of lupus nephritis. Lupus Nephritis Collaborative Study Group. Am J Kidney Dis 1:374–377

    Article  Google Scholar 

  32. Wernick RM, Smith DL, Houghton DC, Phillips DS, Booth JL, Runckel DN, Johnson DS, Brown KK, Gaboury CL (1993) Reliability of histologic scoring for lupus nephritis: a community-based evaluation. Ann Intern Med 119:805–811

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

A substantial portion of this work was performed while M. Zappitelli was receiving post-doctoral research fellowship support from the Kidney Research Scientist Core Education and National Training (KRESCENT) program. Dr. C.M. Duffy was supported by the Sessenwein Research Award, McGill University.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, McGill University Health Center, Room E-222, 2300 Tupper Street, Montreal, Quebec, H3H 1P3, Canada

    Michael Zappitelli

  2. Department of Pediatrics, Division of Rheumatology, McGill University Health Center, Montreal, Quebec, Canada

    Ciarán M. Duffy

  3. Department of Pathology, McGill University Health Center, Montreal, Quebec, Canada

    Chantal Bernard

  4. Department of Pediatrics, Division of Nephrology, McGill University Health Center, Montreal, Quebec, Canada

    Indra R. Gupta

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  1. Michael Zappitelli
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  2. Ciarán M. Duffy
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  3. Chantal Bernard
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  4. Indra R. Gupta
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Correspondence to Michael Zappitelli.

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Zappitelli, M., Duffy, C.M., Bernard, C. et al. Evaluation of activity, chronicity and tubulointerstitial indices for childhood lupus nephritis. Pediatr Nephrol 23, 83–91 (2008). https://doi.org/10.1007/s00467-007-0619-7

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  • DOI: https://doi.org/10.1007/s00467-007-0619-7

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