Objectives The objective of this paper was to evaluate correlations between kidney biopsy indexes (activity and chronicity) and urinary sediment findings; the secondary objective was to find which components of urinary sediment can discriminate proliferative from other classes of lupus nephritis. Methods Lupus nephritis patients scheduled for a kidney biopsy were included in our study. The morning before the kidney biopsy, we took urine samples from each patient. Receiver operating characteristic (ROC) curves were plotted to determine the area under the curve (AUC) of each test for detecting proliferative lupus nephritis; a classification tree was calculated to select a set of values that best-predicted lupus nephritis classes. Results We included 51 patients, 36 of whom were women (70.6%). Correlations of lupus nephritis activity index with the counts in the urinary sediment of erythrocytes (isomorphic and dysmorphic), acanthocytes, and leukocytes were 0.65 ( p < 0.0001) 0.62 ( p < 0.0001) and 0.22 ( p = 0.1228), respectively. Correlations of lupus nephritis chronicity index with the counts of erythrocytes, acanthocytes, and leukocytes were 0.60 ( p ≤ 0.0001), 0.52 ( p = 0.0001) and 0.17 ( p = 0.2300), respectively. Our classification tree had an accuracy of 84.3%. Conclusions Evaluation of urine sediment reflects lupus nephritis histology.

Introduction: Lupus nephritis requires antinuclear antibodies as classification criteria. There is a group of patients with nephrotic syndrome and conclusive histopathological findings for lupus nephritis, without classification criteria for systemic lupus erythematosus (SLE) or extrarenal manifestations. These groups of patients have been described as “lupus-like” nephritis or “renal-limited lupus nephritis”. Methods: Renal biopsy with histopathological evaluation with “full-house” immune-reactants in patients with negative antinuclear antibodies. Results: We report four cases with nephrotic syndrome and one with hematuria-proteinuria syndrome: two with impaired glomerular filtration rate and three with preserved renal function; urinary sediment with hematuria without dysmorphia and without extrarenal manifestations for autoimmune disease, negative antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA); normal C3 and C4 complement levels. Renal biopsy in all cases was consistent for lupus nephritis class V. All patients received treatment as lupus nephritis protocol; only one case received induction with cyclophosphamide and methylprednisolone boluses, the rest received mycophenolic acid and prednisone as induction and maintenance. Two of the cases induced with mycophenolic acid relapsed, requiring cyclophosphamide for 6 months, achieving complete remission. All patients received renin-angiotensin-aldosterone system blockade and hydroxychloroquine. At follow-up, 4 cases still have negative antibodies and are without extrarenal manifestations for SLE classification criteria. The other case, during pregnancy several years after initial diagnosis, had preeclampsia with nephrotic proteinuria and a new determination of positive ANA and anti-dsDNA antibodies, complement levels below normal limits. Conclusion: The follow-up of patients with membranous glomerulopathy must be close; lupus like nephritis may be the first manifestation of the disease.

BackgroundIn 1983 Austin et al. informed a series of prognostic factors (including histology) associated with the development of renal failure in patients with lupus nephritis (LN). Differences in actual therapies may have different hazard ratios of renal failure than the described by Austin et al.1ObjectivesTo evaluate histological factors associated with a decline in kidney function (DKF) in patients with SLE.MethodsWe evaluated all the patients in whom a kidney biopsy was performed. DKF was defined as a glomerular filtration rate (GFR) of less than 60 ml/min/m2 in two determinations in the follow-up. Histology was graded according to Austin et al.1 (activity and chronicity) by a renal pathology specialist. Factors associated with the development of DKF were evaluated through Kaplan-Meier curves and Cox regression analysis (bivariate and multivariate).ResultsAt this moment, we have followed 170 patients with LN and kidney biopsy, 130 (76.5%) women, mean age at kidney biopsy was 29.7±13.2 years; classes of LN were: 71 patients (41.8%) class IV, 30 (17.6%) class V, 22 (12.9%) class III/V, 19 (11.2%) class IV/V, 16 (9.4%) class III, and other classes 12 patients; 135 patients (79.5%) have a minimum follow-up of 12 months. There were statistically significant differences in four groups of LN: pure proliferative (classes III or IV), the combination with membranous (III/IV±V), pure membranous (V) or other classes (Figure1).In the bivariate analysis, factors statistically significant associated with the development of DKF were: glomerular sclerosis, fibrous crescents, interstitial cell infiltration and tubular atrophy; having membranous component resulted as a “protector” factor for the development of DKF. The Cox regression model included all the factors with a p-value less than 0.25 in the bivariate analysis; independent factors associated with increased HR of DKF were glomerular sclerosis and fibrous crescents; however, hyaline thrombi and presence of membranous nephritis were associated with a decreased HR of DKF. (Table 1).Table 1.Factors associated with a DKFHistological featureBivariateBivariateMultivariateMultivariate HR (CI)p-valueHR (CI)p-value Glomerular abnormalities Cellular proliferation1.01 (0.83–1.22)0.920NANA Karyorrhexis0.94 (0.76–1.17)0.566NANA Celular crescents1.09 (0.96–1.22)0.1790.95 (0.82–1.10)0.501484 Hyaline thrombi0.85 (0.64–1.12)0.2480.65 (0.47–0.90)0.008837 Leukocyte infiltration1.23 (0.97–1.57)0.08481.03 (0.77–1.40)0.815447 Glomerular sclerosis1.79 (1.41–2.26)<0.0011.67 (1.23–2.25)0.000838 Fibrous crescents1.71 (1.27–2.29)<0.0011.55 (1.11–2.16)0.009917 Membranous0.50 (0.30–0.85)0.01050.48 (0.27–0.88)0.017001Tubulointerstitial abnormalities Interstitial cell infiltration1.31 (1.13–1.56)<0.0011.18 (0.95–1.47)0.126099 Interstitial fibrosis0.80 (0.92–1.70)0.1620.74 (0.47–1.16)0.194012 Tubular atrophy1.33 (1.02–1.74)0.0351.10 (0.47–1.17)0.613154ConclusionsWe describe factors associated with a DKF. We found that the proliferative LN in combination with membranous have a better prognosis than pu...