TY - JOUR
T1 - Validation of the Lupus Nephritis Clinical Indices in Childhood-Onset Systemic Lupus Erythematosus
AU - Mina, Rina
AU - Abulaban, Khalid
AU - Klein-Gitelman, Marisa S.
AU - Eberhard, Barbara A.
AU - Ardoin, Stacy P.
AU - Singer, Nora
AU - Onel, Karen
AU - Tucker, Lori
AU - O'Neil, Kathleen
AU - Wright, Tracey
AU - Brooks, Elizabeth
AU - Rouster-Stevens, Kelly
AU - Jung, Lawrence
AU - Imundo, Lisa
AU - Rovin, Brad
AU - Witte, David
AU - Ying, Jun
AU - Brunner, Hermine I.
N1 - Funding Information:
For data collection and management, the authors thank Lukasz Itert, Melanie Hhalol, Kasha Wiley (Cincinnati Children?s Hospital Medical Center, Cincinnati, OH), Shannen Nelson (Children?s Hospital, Los Angeles, CA), Sheena Kapoor, Nicole Battle (Children?s National Medical Center, Washington, DC), Lori Ponder (Children?s Healthcare of Atlanta, Emory University, Atlanta, GA), Michael Miller, MD, Megan Curran, MD, Erin Thomas and Alexandra Martyniuk (Lurie Children?s Hospital, Chicago, IL), Angelynne Sarmiento, David Cabral, MD, Kristin Houghton, Kimberly Morishita, Jaime Guzman (British Columbia Children?s Hospital, Vancouver, British Columbia), and Rebecca Puplava (University of Chicago Comer Children?s Hospital, Chicago, IL). Dr. Mina?s work was supported by the University of Cincinnati Center for Clinical & Translational Science & Training. Dr. Brunner?s work was supported by the NIH (grants U0-AR-059509 and U0-AR-065098).
Funding Information:
For data collection and management, the authors thank Lukasz Itert, Melanie Hhalol, Kasha Wiley (Cincinnati Children’s Hospital Medical Center, Cincinnati, OH), Shannen Nelson (Children’s Hospital, Los Angeles, CA), Sheena Kapoor, Nicole Battle (Children’s National Medical Center, Washington, DC), Lori Ponder (Children’s Healthcare of Atlanta, Emory University, Atlanta, GA), Michael Miller, MD, Megan Curran, MD, Erin Thomas and Alexandra Martyniuk (Lurie Children’s Hospital, Chicago, IL), Angelynne Sarmiento, David Cabral, MD, Kristin Houghton, Kimberly Morishita, Jaime Guzman (British Columbia Children’s Hospital, Vancouver, British Columbia), and Rebecca Puplava (University of Chicago Comer Children’s Hospital, Chicago, IL). Dr. Mina’s work was supported by the University of Cincinnati Center for Clinical & Translational Science & Training. Dr. Brunner’s work was supported by the NIH (grants U0-AR-059509 and U0-AR-065098).
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Objective To validate clinical indices of lupus nephritis activity and damage when used in children against the criterion standard of kidney biopsy findings. Methods In 83 children requiring kidney biopsy, the Systemic Lupus Erythematosus Disease Activity Index renal domain (SLEDAI-R), British Isles Lupus Assessment Group index renal domain (BILAG-R), Systemic Lupus International Collaborating Clinics (SLICC) renal activity score (SLICC-RAS), and SLICC Damage Index renal domain (SDI-R) were measured. Fixed effects and logistic models were calculated to predict International Society of Nephrology/Renal Pathology Society (ISN/RPS) class; low-to-moderate versus high lupus nephritis activity (National Institutes of Health [NIH] activity index [AI]) score: ≤10 versus >10; tubulointerstitial activity index (TIAI) score: ≤5 versus >5; or the absence versus presence of lupus nephritis chronicity (NIH chronicity index) score: 0 versus ≥1. Results There were 10, 50, and 23 patients with ISN/RPS class I/II, III/IV, and V, respectively. Scores of the clinical indices did not differentiate among patients by ISN/RPS class. The SLEDAI-R and SLICC-RAS but not the BILAG-R differed with lupus nephritis activity status defined by NIH-AI scores, while only the SLEDAI-R scores differed between lupus nephritis activity status based on TIAI scores. The sensitivity and specificity of the SDI-R to capture lupus nephritis chronicity was 23.5% and 91.7%, respectively. Despite being designed to measure lupus nephritis activity, SLICC-RAS and SLEDAI-R scores significantly differed with lupus nephritis chronicity status. Conclusion Current clinical indices of lupus nephritis fail to discriminate ISN/RPS class in children. Despite its shortcomings, the SLEDAI-R appears best for measuring lupus nephritis activity in a clinical setting. The SDI-R is a poor correlate of lupus nephritis chronicity.
AB - Objective To validate clinical indices of lupus nephritis activity and damage when used in children against the criterion standard of kidney biopsy findings. Methods In 83 children requiring kidney biopsy, the Systemic Lupus Erythematosus Disease Activity Index renal domain (SLEDAI-R), British Isles Lupus Assessment Group index renal domain (BILAG-R), Systemic Lupus International Collaborating Clinics (SLICC) renal activity score (SLICC-RAS), and SLICC Damage Index renal domain (SDI-R) were measured. Fixed effects and logistic models were calculated to predict International Society of Nephrology/Renal Pathology Society (ISN/RPS) class; low-to-moderate versus high lupus nephritis activity (National Institutes of Health [NIH] activity index [AI]) score: ≤10 versus >10; tubulointerstitial activity index (TIAI) score: ≤5 versus >5; or the absence versus presence of lupus nephritis chronicity (NIH chronicity index) score: 0 versus ≥1. Results There were 10, 50, and 23 patients with ISN/RPS class I/II, III/IV, and V, respectively. Scores of the clinical indices did not differentiate among patients by ISN/RPS class. The SLEDAI-R and SLICC-RAS but not the BILAG-R differed with lupus nephritis activity status defined by NIH-AI scores, while only the SLEDAI-R scores differed between lupus nephritis activity status based on TIAI scores. The sensitivity and specificity of the SDI-R to capture lupus nephritis chronicity was 23.5% and 91.7%, respectively. Despite being designed to measure lupus nephritis activity, SLICC-RAS and SLEDAI-R scores significantly differed with lupus nephritis chronicity status. Conclusion Current clinical indices of lupus nephritis fail to discriminate ISN/RPS class in children. Despite its shortcomings, the SLEDAI-R appears best for measuring lupus nephritis activity in a clinical setting. The SDI-R is a poor correlate of lupus nephritis chronicity.
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U2 - 10.1002/acr.22651
DO - 10.1002/acr.22651
M3 - Article
C2 - 26213987
AN - SCOPUS:84957108238
VL - 68
SP - 195
EP - 202
JO - Arthritis Care and Research
JF - Arthritis Care and Research
SN - 2151-464X
IS - 2
ER -