title: The spectrum of renal involvement in patients with inflammatory myopathies.
abstract: Data regarding the incidence and outcome of renal involvement in patients with inflammatory myopathies (IM) remain scarce. We assessed the incidence and causes of acute kidney injury (AKI) and chronic kidney disease (CKD) in 150 patients with dermatomyositis, polymyositis, and antisynthetase syndrome followed in 3 French referral centers. Renal involvement occurred in 35 (23.3%) patients: AKI in 16 (10.7%), and CKD in 31 (20.7%) patients. The main cause of AKI was drug or myoglobinuria-induced acute tubular necrosis. Male sex, cardiovascular risk factors, cardiac involvement, and initial proteinuria >0.3 g/d were associated with the occurrence of AKI. The outcome of patients with AKI was poor: 13 (81%) progressed to CKD and 2 (12.5%) reached end-stage renal disease. In multivariate survival analysis, age at IM onset, male sex, a history of cardiovascular events, and a previous episode of AKI were associated with the risk of CKD. We also identified 14 IM patients who underwent a kidney biopsy in 10 nephrology centers. Renal pathology disclosed a wide range of renal disorders, mainly immune-complex glomerulonephritis. We identified in 5 patients a peculiar pattern of severe acute renal vascular damage consisting mainly of edematous thickening of the intima of arterioles. We found that AKI and CKD are frequent in patients with IM. Prevention of AKI is crucial in these patients, as AKI is a major contributor to their relatively high risk of CKD. A peculiar pattern of acute vascular damage is part of the spectrum of renal diseases associated with IM.
authors.affiliation: From Department of Nephrology and Immunology (GC-D, FF), UMR S 1064, ITUN, Department of Internal Medicine (A. Masseau, JM-M, MH), and Department of Pathology (A. Moreau), CHU de Nantes, Nantes; Department 1 (OB) (French Reference Centre for Neuromuscular diseases), Department 2 (BH) (French Reference Centre for Lupus) of Internal Medicine, and Department of Pathology (P. Rouvier), CHU de la Pitié-Salpêtrière, APHP, Paris; SPHERE (bioStatistics, Pharmacoepidemiology and Human sciEnces Research) Laboratory (AB, ED)-EA 4275, LabEx Transplantex, Nantes University, Nantes; Department of Pathology (DB) and Department of Internal Medicine (EH), CHU de Lille, Lille; Department of Nephrology (P. Remy), CHU Henri Mondor, Creteil; Department of Nephrology ( RA), CH de Dunkerque; Dunkerque; Department of Nephrology (EMN), CH de Bethune, Bethune; Department of Pathology (BM) and Department of Nephrology (ML), CHU Edouard Herriot, Lyon; Department of Pathology (LD), CHU la Timone, Marseille; Department of Nephrology (AL), CHU de Bordeaux, Bordeaux; Department of Neurology (TDB), Centre Hospitalier de Saint-Denis, Saint Denis; and Department of Internal Medicine (PC), Hôpital de Sainte-Anne, Toulon; France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Couvrat-Desvergnes
authors.forename: Agathe
authors.initials: A
authors.lastname: Masseau
authors.forename: Olivier
authors.initials: O
authors.lastname: Benveniste
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bruel
authors.forename: Baptiste
authors.initials: B
authors.lastname: Hervier
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Mussini
authors.forename: David
authors.initials: D
authors.lastname: Buob
authors.forename: Eric
authors.initials: E
authors.lastname: Hachulla
authors.forename: Philippe
authors.initials: P
authors.lastname: Rémy
authors.forename: Raymond
authors.initials: R
authors.lastname: Azar
authors.forename: Evelyne Mac
authors.initials: EM
authors.lastname: Namara
authors.forename: Brigitte
authors.initials: B
authors.lastname: MacGregor
authors.forename: Laurent
authors.initials: L
authors.lastname: Daniel
authors.forename: Adeline
authors.initials: A
authors.lastname: Lacraz
authors.forename: Thomas De
authors.initials: T
authors.lastname: Broucker
authors.forename: Philippe
authors.initials: P
authors.lastname: Rouvier
authors.forename: Philippe
authors.initials: P
authors.lastname: Carli
authors.forename: Maurice
authors.initials: M
authors.lastname: Laville
authors.forename: Etienne
authors.initials: E
authors.lastname: Dantan
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hamidou
authors.forename: Anne
authors.initials: A
authors.lastname: Moreau
authors.forename: Fadi
authors.initials: F
authors.lastname: Fakhouri
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000150:complications* / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies