title: Renal Thrombotic Microangiopathy in Proliferative Lupus Nephritis: Risk Factors and Clinical Outcomes: A Case-Control Study.
abstract: BACKGROUND
  Renal thrombotic microangiopathy (TMA) may be associated with lupus nephritis. Its relationship to other disease factors and its specific effect on prognosis are not precisely known. Evidence regarding these aspects is controversial, and information focusing on kidney-limited TMA in systemic lupus erythematosus (SLE) patients is scarce.
  
  
  OBJECTIVE
  The aims of this study were to identify risk factors for renal TMA in patients with lupus nephritis and to determine its impact on clinical outcomes.
  
  
  METHODS
  A case-control study was performed. We studied 245 renal biopsies from SLE patients. We included patients with renal TMA, as well as control subjects adjusted for glomerulonephritis class, estimated glomerular filtration rate, activity and chronicity indices, and follow-up time. Serological and clinical features were measured at the time of the biopsy and during follow-up.
  
  
  RESULTS
  Twenty-three patients with renal TMA and 21 control subjects were included. There were no differences in Systemic Lupus Erythematosus Disease Activity Index score, end-stage renal disease, or mortality between groups during follow-up. After multivariate analysis, lymphopenia (odds ratio, 10.69; 95% CI, 1.35-84.74) and anti-Ro antibody positivity (odds ratio, 8.96; 95% CI, 1.49-53.57) remained significantly associated with renal TMA.
  
  
  CONCLUSIONS
  Lymphopenia and anti-Ro positivity are independent risk factors for renal TMA in SLE patients. This increased risk could be a consequence of the potential role of these factors in endothelial dysfunction and damage. Outcomes were similar for patients with the same estimated glomerular filtration rate and biopsy characteristics, regardless of the presence of TMA.
authors.affiliation: From the Departments of *Immunology and Rheumatology, †Nephrology and Mineral Metabolism; and ‡Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Ana
authors.initials: A
authors.lastname: Barrera-Vargas
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Rosado-Canto
authors.forename: Javier
authors.initials: J
authors.lastname: Merayo-Chalico
authors.forename: José M
authors.initials: JM
authors.lastname: Arreola-Guerra
authors.forename: Juan M
authors.initials: JM
authors.lastname: Mejía-Vilet
authors.forename: Ricardo
authors.initials: R
authors.lastname: Correa-Rotter
authors.forename: Diana
authors.initials: D
authors.lastname: Gómez-Martín
authors.forename: Jorge
authors.initials: J
authors.lastname: Alcocer-Varela
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000032:analysis; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001706:Biopsy / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008181:Lupus Nephritis / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D018655:Lymphocyte Count / Q000379:methods; D008297:Male; D008800:Mexico; D010043:Outcome and Process Assessment, Health Care; D062072:Patient Acuity; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors; D057049:Thrombotic Microangiopathies / Q000473:pathology / Q000503:physiopathology
chemical_list: D017152:Antibodies, Antiphospholipid; D018501:Antirheumatic Agents