Endocapillary hypercellularity levels are associated with early complete remission in children with class IV lupus nephritis as the initial presentation of SLE

• Published in: BMC nephrology Vol. 23; no. 1; pp. 1 - 296
• Main Authors: Li, Chunzhen, Han, Yanan, Zhang, Lili, Chen, Zhiguo, Jin, Mei, Sun, Suzhen
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 26-08-2022; BioMed Central; BMC
• Subjects: Antibodies; Antigens; Biopsy; Blood; Care and treatment; Clinical outcomes; Complete remission; Complications and side effects; Creatinine; Development and progression; Diagnosis; Endocapillary hypercellularity; Ethics; Glomerular filtration rate; Immunosuppressive agents; Induction therapy; Kidneys; Laboratories; Lupus; Lupus nephritis; Medical examination; Nephritis; Nephrology; Pathology; Patients; Pediatric lupus nephritis; Pediatric urology; Pediatrics; Proteins; Remission; Remission (Medicine); Risk factors; Services; Systemic lupus erythematosus; Urine; China; Hebei China
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-022-02921-5

Abstract
Background
Endocapillary hypercellularity (ECHC) is commonly seen in class IV lupus nephritis (LN), the most common and severe LN in children. Factors influencing early complete remission (CR) in pediatric class IV LN have been poorly described. We investigated the relationship between ECHC levels and early CR in pediatric class IV LN.
Methods
Patients with newly, simultaneously diagnosed systemic lupus erythematosus (SLE) and class IV LN by renal biopsy from 2012 to 2021 were studied. In this retrospective study, two pathologists who were blind to clinical information reviewed all pathological data retrospectively and classified glomerular lesions according to the revised criteria of the International Society of Nephrology and the Renal Pathology Society (ISN/RPS). The demographics, baseline clinical characteristics, laboratory parameters, renal histopathological findings, treatment regimen and CR at 6 months after immunosuppressive therapy were analyzed. ECHC was categorized as: > 50% (group A), 25–50% (group B) and < 25% (group C). CR was defined as absence of clinical symptoms, 24-hour urinary protein < 0.15 g, and normal levels of serum creatinine and albumin.
Results
Sixty-four patients were identified: 23, 15 and 26 in groups A, B and C, respectively. Group A had significantly higher levels of D-dimer, urine protein, and SLE disease activity index (SLEDAI) than groups B and C. Group C had a markedly higher estimated glomerular filtration rate (eGFR) than groups A and B. A substantially greater proportion of patients in group A had glomerular microthrombi and basement membrane thickening than in groups B and C. At 6 months post treatment, CR was achieved in 19 (82.6%), 5 (33.3%) and 11 (42.3%) in groups A, B and C, respectively (
p
 < 0.05, group A vs groups B and C). Multiple logistic regression analysis revealed that ECHC and urine protein levels were significantly associated with CR.
Conclusion
ECHC and urine protein levels may be valuable biomarkers for predicting early CR in pediatric class IV LN.