"Background: proliferative lupus nephritis (LN) has higher prevalence and worse prognosis than non-proliferative LN. Renal biopsy plays an important role in diagnosis and therapy of LN, but there are some obstacles in its implementation. A diagnostic scoring system for proliferative LN is necessary, especially for cases in which renal biopsy cannot be performed. This study aimed to develop a diagnostic scoring system of proliferative LN based on its diagnostic determinants including hypertension, proteinuria, hematuria, eGFR, anti-dsDNA antibody, and C3 levels.
Methods: a cross-sectional study with total sampling method was conducted. Our subjects were adult LN patients who underwent renal biopsy in Cipto Mangunkusumo Hospital between January 2007 and June 2017.
Results: from a total of 191 subjects with biopsy-proven LN in this study, we found a proportion of proliferative LN of 74.8%. There were 113 subjects included for analysis of proliferative LN determinants. The multivariate analysis demonstrated that determinants for proliferative LN were hypertension (OR 3.39; 95% CI 1.30-8.84), eGFR <60ml/min/1.73m2 (OR 9.095; 95% CI 1.11-74.68), and low C3 levels (OR 3.97; 95% CI 1.41-11.17). After further analysis, we found that hypertension, eGFR <60ml/min/1.73m2, low C3 levels, and hematuria were essential components of the diagnostic scoring system on proliferative LN. The scoring system was tested with ROC curve and an AUC of 80.4% was obtained (95% CI 71.9-89).
Conclusion: the proportion of proliferative LN in biopsy-proven LN patients of Cipto Mangunkusumo Hospital is 74.8%. Components of scoring system for proliferative LN consist of hypertension, eGFR <60ml/min/1.73m2, low C3 levels, and hematuria.
Latar belakang: nefritis lupus (NL) proliferatif memiliki prevalensi yang lebih tinggi dan prognosis yang lebih buruk dibandingkan NL non-proliferatif. Pemeriksaan histopatologi memegang peranan penting dalam diagnosis dan terapi NL proliferatif, namun terdapat beberapa kendala dalam pelaksanaannya. Sistem skor NL proliferatif diperlukan untuk membantu diagnosis NL proliferatif terutama pada kondisi biopsi ginjal tidak dapat dilakukan. Tujuan penelitian adalah menetapkan sistem skor diagnosis NL proliferatif berdasarkan determinan hipertensi, proteinuria, hematuria, eGFR, kadar anti-dsDNA, dan C3. Metode: penelitian diagnostik dengan desain potong-lintang terhadap 113 pasien NL yang terbukti dari pemeriksaan Patologi Anatomik di RSCM sejak Januari 2007 hingga Juni 2017 dengan metode total sampling. Data yang digunakan adalah data sekunder. Analisis data dilakukan dengan program statistik SPSS Statistics 20.0 untuk analisis univariat, bivariat, multivariat, Receiving Characteristics Operator, serta analisis bootstrapping pada Kalibrasi Hosmer-Lemeshow.Hasil: sebanyak 191 subjek dianalisis untuk proporsi NL proliferatif, didapatkan proporsi NL proliferatif pada pasien NL yang terbukti dari biopsi ginjal di RSCM sebesar 74,8%. Sebanyak 113 subjek dianalisis untuk mendapatkan determinan NL proliferatif. Pada analisis multivariat, hipertensi (OR= 3,39; 95%IK 1,30-8,84), eGFR <60ml/min/1,73m2 (OR= 9,095; 95%IK 1,11-74,68), dan penurunan kadar C3 (OR= 3,97; 95%IK 1,41-11,17) merupakan determinan NL proliferatif. Hipertensi, eGFR <60ml/min/1,73m2, penurunan kadar C3, dan hematuria, menjadi bagian sistem skor diagnosis NL proliferatif. Pada kurva ROC didapatkan AUC sebesar 80,4% (95% IK 71,9-89), dengan titik potong skor 3. Kesimpulan: proporsi NL proliferatif pada pasien NL yang terbukti dari biopsi ginjal di RSCM adalah 74,8%. Komponen sistem skor diagnosis NL proliferatif terdiri dari hipertensi, eGFR <60ml/menit/1.73m2, penurunan kadar C3, dan hematuria."