G. J. Pons Estel7, R. Quintana7, R. Nieto7, H. Brunner44, M. Scolnik1, C. Funes Soaje2, P. Alba3, V. Saurit4, M. A. García5, G. Berbotto6, V. Bellomio8, E. Kerzberg9, G. Gómez10, C. Pisoni11, V. Juarez12, A. Malvar13, N. A da Silva14, O. A. Monticielo15, H. A. Mariz16, F. Machado Ribeiro17, E. F. Borba18, E. Bonfa18, E. Torres dos Reis Neto19, I. Guerra Herrera20, L. Massardo21, G. Aroca Martinez22, L. Gómez Escorcia22, C. A. Cañas Davila23, G. Quintana-Lopez43, C. E. Toro-Gutierrez24, M. Moreno Alvarez25, M. A. Saavedra Salinas26, M. Portela Hernandez27, H. Fragoso Loyo28, L. Silveira29, I. García De La Torre30, C. Abud Mendoza31, J. A. Esquivel-Valerio32, I. Acosta Colman, A. Paats33, C. Mora Trujillo34, M. F. Ugarte-Gil35, A. Calvo Quiroz36, R. Muñoz Louis37, M. Rebella38, Á. Danza39, F. Zazzetti40, A. Orillion PhD41, U. Sbarigia42, B. Pons-Estel7
1Seccion Reumatologia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
2Hospital Italiano de Córdoba, Córdoba, Argentina
3Servicio de Reumatología Hospital Córdoba y Sanatorio Allende, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
4Hospital Privado Centro médico de Córdoba, Córdoba, Argentina
5Hospital San Martin de La Plata, Buenos Aires, Argentina
6Sanatorio Británico, Rosario, Argentina
7Centro Regional de Enfermedades Autoinmunes y Reumáticas, GO-CREAR, Rosario, Argentina
8Hospital Padilla, San Miguel de Tucumán, Argentina
9Hospital J.M Ramos Mejía, Buenos Aires, Argentina
10Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
11CEMIC Centro de Educación Médica e Investigaciones Clínicas ‘‘Norberto Quirno’’, Buenos Aires, Argentina
12Hospital Señor del Milagro Salta, Servicio de Reumatología, Salta, Argentina
13Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
14Rheumatology Unit- Hospital das Clinicas da Universidade Federal de Goias, Goiânia, Brazil
15Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
16Universidad Federal de Pernambuco, Recife, Brazil
17Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
18Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, USP, São Paulo, Brazil
19Division of Rheumatology, Escola Paulista de Medicina/ Universidade federal de São Paulo (EPM/ Unifesp), São Paulo, Brazil
20Hospital del Salvador Santiago de Chile, Santiago, Chile
21Facultad de Medicina y CIencia, Universidad San Sebastián, Santiago, Chile
22Clínica de la Costa y Universidad Simón Bolívar Barranquilla, Barranquilla, Colombia
23Fundación Valle del Lili, Universidad Icesi, Cali, Colombia
24Centro de Referencia en Osteoporosis & Reumatología, Pontificia Universidad Javeriana de Cali, Cali, Colombia
25Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
26División de Investigación en Salud, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
27Hospital de especialidades del centro médico nacional SXXI, Instituto Mexicano del seguro social (IMSS), Mexico City, Mexico
28Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
29Instituto Nacional de Cardiología Ignacio Chávez, Departamento de Inmunología, Mexico City, Mexico
30Centro de Estudios de Investigación Básica y Clínica, S.C., Guadalajara, Mexico
31Facultad de Medicina de la Universidad Autónoma de San Luis Potosí y Hospital Central “Dr. Ignacio Morones Prieto”, San Luis Potosí, Mexico
32Servicio de Reumatologia, Hospital Universitario “Dr. José Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
33Facultad de Ciencias Medicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
34Hospital Nacional Edgardo Rebagliati Martins-EsSalud, Lima, Peru
35Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Servicio de Reumatología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
36Servicio de Inmunología y Reumatología, Hospital Nacional Cayetano Heredia, Universidad Peruana Cayetano Heredia, Lima, Peru
37Hospital Docente Padre Billini, Santo Domingo, Dominican Republic
38Unidad de Enfermedades Autoinmunes Sistémicas, Hospital de Clínicas, Facultad de Medicina, UDELAR, Montevideo, Uruguay
39Médica Uruguaya, Facultad de Medicina - Universidad de la República, Montevideo, Uruguay
40Johnson & Johnson, Horsham, PA, United States of America
41Johnson & Johnson, Spring House, PA, United States of America
42Johnson & Johnson, Brussels, Belgium
43Facultad de Medicina, Universidad Nacional de Colombia; Servicio de reumatología, Hospital Universitario Fundación Santa Fe de Bogotá; Hospital Universitario Nacional de Colombia, Bogotá, Colombia
44UC Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
Background: Effective, non-invasive disease activity and treatment response assessments are needed for patients with systemic lupus erythematosus (SLE), especially if associated with kidney disease, i.e. lupus nephritis (LN). The treatment goal of LN is to achieve complete renal remission (CRR). Proteinuria of >0.5 g/day can prompt a kidney biopsy to diagnose LN. The Renal Activity Index for Lupus (RAIL) measures the degree of kidney inflammation. The RAIL-score is calculated from the creatinine-adjusted RAIL biomarkers (NGAL, KIM-1, MCP-1, adiponectin, hemopexin, ceruloplasmin) and higher scores indicate higher kidney inflammation [1].
Objectives: 1
) Evaluate the role of RAIL to distinguish CRR status and identify the cut-point for RAIL;
2
) Evaluate the role of RAIL in predicting change in CRR status over time.
Methods: Urine samples were collected from 69 SLE adult patients (pts) with and without LN were studied longitudinally at enrollment into the GLADEL cohort (T0), at 6 months (T1) and 12 months (T2). Absolute scores and changes in RAIL-scores over time were assessed for presence of CRR status [proteinuria of < 0.5 g/day] by logistical regression models. The Youden Index optimal cut-points on the ROC curves were calculated.
Results: For 186 visits from 51 (74%; 91% female) pts with LN and 18 (26%) pts without LN diagnosis, pt characteristics and disease courses are shown in Table 1. RAIL-scores were correlated with renal-SLEDAI (r=0.46; p<0.0001) and proteinuria (r=0.37; p=0.002). Considering all visits (CRR present/absent=146/40), mean±SD RAIL-scores with CRR-status were 1.17±1.53 lower than without CRR (p=0.023; area under the ROC curve =0.73), as shown in Figure 1, RAIL scores of no more than 3.4 identified CRR-status with 78% specificity (Positive Predictive Value (PPV)=0.77, sensitivity =62). Pts who newly achieved CRR-status at the next visit had a mean±SD RAIL-score decrease of 1.0±1.524 since the last visit (Percentage Variance Value (PVV)= 82% p=0.0024) and a further decrease of ≥0.57 of achieving CRR at the next visit.
Conclusion: RAIL-scores are significantly lower with CRR-status in LN and decreases of 1.0 between visits >0.57 or larger may predict future CRR achievement.
REFERENCES: [1] Brunner HI, et al. Arthritis Care Res (Hoboken). 2016;68(7):1003-11.
Table 1.
Patient characteristics & RAIL-scores over time.
Acknowledgements: NIL.
Disclosure of Interests: Guillermo Javier Pons Estel AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, AstraZeneca, Boehringer Ingelheim, GSK, Janssen, Novartis, Pfizer, RemeGen, Sanofi and Werfen Diagnostics, Rosana Quintana: None declared, Romina Nieto: None declared, Hermine Brunner: None declared, Marina Scolnik GSK, Astrazeneca, Janssen, Roche, Pfizer, GSK, Astrazeneca, Janssen, Roche, Pfizer, Carmen Funes Soaje: None declared, Paula Alba: None declared, Verónica Saurit: None declared, Mercedes Argentina García: None declared, Guillermo Berbotto: None declared, Verónica Bellomio: None declared, Eduardo Kerzberg: None declared, Graciela Gómez: None declared, Cecilia Pisoni: None declared, Vicente Juarez: None declared, Ana Malvar: None declared, Nílzio A. da Silva: None declared, Odirlei André Monticielo: None declared, Henrique Ataide Mariz: None declared, Francinne Machado Ribeiro: None declared, Eduardo F. Borba: None declared, Eloisa Bonfa: None declared, Edgard Torres dos Reis Neto: None declared, Iris Guerra Herrera: None declared, Loreto Massardo: None declared, Gustavo Aroca Martinez: None declared, Lorena Gómez Escorcia: None declared, Carlos A. Cañas Davila: None declared, Gerardo Quintana-Lopez: None declared, Carlos Enrique Toro-Gutierrez: None declared, Mario Moreno Alvarez: None declared, Miguel A. Saavedra Salinas: None declared, Margarita Portela Hernandez: None declared, Hilda Fragoso Loyo: None declared, Luis Silveira: None declared, Ignacio García De La Torre: None declared, Carlos Abud Mendoza: None declared, Jorge Antonio Esquivel-Valerio: None declared, Isabel Acosta Colman: None declared, Astrid Paats: None declared, Claudia Mora Trujillo: None declared, Manuel F. Ugarte-Gil Speaker: GlaxoSmithKline and AstraZeneca. Advisory boards: AstraZeneca and Ferrer, Janssen, Armando Calvo Quiroz: None declared, Roberto Muñoz Louis: None declared, Martin Rebella: None declared, Álvaro Danza: None declared, Federico Zazzetti Johnson & Johnson, Johnson & Johnson, Ashley Orillion, PhD Johnson & Johnson, Johnson & Johnson, Urbano Sbarigia Johnson & Johnson, Johnson & Johnson, Bernardo Pons-Estel AstraZeneca, GSK, Janssen.
