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Background: Interstitial fibrosis is associated with poor long term outcome in many kidney diseases. We investigated the predictive value of extracellular matrix quantification on long term outcome in patient with lupus nephritis.
Methods: A cohort of 43 patients with lupus nephritis (LN) was followed from the time of biopsy. Kidney biopsy specimens were stained with picro-sirius red. The magnitude of fibrotic tissue was calculated by computerized image analysis. Each biopsy tissue was evaluated for different parameters: collagenous matrix index (CMI), fibrillary collagen index (FCI), activity index and chronicity index.
Result: At baseline, median serum creatinine(Cr) was 0.8 mg/dl and mean eGFR was 90.3 ± 37.6 ml/min/ 1.73 m2. Median follow up was 56.4 (range 1.2 - 13.2) months. Thirty-three patients achieved remission (22 complete remission, 11 partial remission), 20 patients had decreased 25%eGFR, 6 patients had renal failure (dialysis, eGFR<15 or Cr >5) and 9 patients died. At the time of biopsy, the activity index correlated with Cr, eGFR and proteinuria. Chronicity index correlated with Cr and eGFR. CMI correlated with Cr and tended to correlate with eGFR. Low CMI predicted good long term renal outcome as assessed by 25% decreased eGFR, renal failure and death. Low activity index was associated with earlier remission. The activity index, chronicity index and FCI predicted of long term renal outcome.
Summary: A computerized system for extracellular matrix quantification of LN predicts long term renal outcome. Future studies are necessary to determine benefit.
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