#1833 Analysis of clinical and laboratory manifestations in different classes of lupus nephritis—a Serbian single center experience

Abstract

Abstract Background and Aims Lupus nephritis represents one of the most serious manifestations of systemic lupus erythematosus. The gold standard for determining the class of lupus nephritis is percutaneous kidney biopsy and the histopathological analysis of the biopsy specimen. The aim of this study was to analyze the clinical and laboratory characteristics of different histopathological classes of lupus nephritis (LN) at the time of the systemic lupus diagnosis and onset of symptoms. Method This retrospective cross-sectional study included a total of 54 subjects who were hospitalized at the Clinic for Nephrology and Clinical Immunology of the University Clinical Center of Vojvodina from 2017 to 2022 and underwent percutaneous kidney biopsy. Available clinical and laboratory data, as well as the histopathological findings of kidney biopsies, were analyzed. Based on the histopathological classification, patients were divided into four groups (Class II, III, IV, and V), and the clinical and laboratory characteristics were analyzed for all subjects. Due to a low number of patients, no analysis of Class I and Class VI was made. Results The most prevalent class among the subjects was Class IV, in which the lowest values of the C3 complement component were recorded. Subjects in this LN class had higher blood pressure values, a higher frequency of clinical manifestations such as arthralgia, and joint swelling. Class IV LN was also associated with elevated anti-dsDNA antibody values with a significant statistical significance (p = 0.004), lower red blood cell parameters, and higher levels of nitrogenous substances compared to other classes. The lowest values of total serum proteins and albumins, as well as the highest values of total cholesterol, LDL cholesterol, and triglycerides, were observed in the group of subjects with Class V LN; C-reactive protein had the highest average values in Class III and IV, which showed a statistical significance (p = 0.007). The lowest values of total serum calcium and iron were in Class III, and 24-hour proteinuria was most pronounced in Class V (p = 0.001), whereas microscopic hematuria was most present in Class II LN (p = 0.03). Conclusion Patients with lupus nephritis exhibit different clinical and laboratory manifestations based on histopathological classification and the time of diagnosis. The results of this study suggest their potential use in diagnosis, assessment of histopathological classification, and the development of a targeted and personalized therapeutic approach. These parameters will be used to develop machine learning models which might help in further evaluation and treatment.