Prognostic significance of renal vascular pathology in lupus nephritis.
We performed a retrospective cohort analysis to define the prognostic significance of vascular lesions documented in renal biopsies of lupus nephritis patients. A total of 429 patients were segregated into five groups: (1) no vascular lesions (NVL), (2) arterial sclerosis (AS), (3) non-inflammatory necrotizing vasculitis (NNV), (4) thrombotic microangiopathy (TMA), and (5) true renal vasculitis (TRV). Renal outcomes were analyzed by Cox regression models, and correlations between vascular lesions and activity/chronicity scores were determined by Spearman's coefficients. A total of 200 (46.6%) had NVL, 189 (44.0%) AS, six NNV (1.4%), 23 (5.4%) TMA, and 11 (2.6%) TRV. Patients with NVL were younger, with higher renal function; patients with TMA and TRV had lower renal function and higher arterial pressure at baseline. Antiphospholipid syndrome and positive lupus anticoagulant were more frequently observed in the TMA group. Five-year renal survival was 83% for NVL, 63% for AS, 67% for NNV, 31% for TMA, and 33% for TRV. NNV and TRV were significantly correlated with activity scores, while AS and chronic TMA were correlated with chronicity scores. Renal vascular lesions are associated with renal outcomes but do not behave as independent factors. The addition of vascular lesions to currently used scores should be further explored.
1 Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico.
J M
JM
Mejía-Vilet
1 Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico.
B M
BM
Córdova-Sánchez
2 Department of Pathology, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico.
N O
NO
Uribe-Uribe
1 Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico.
R
R
Correa-Rotter
1 Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico.
L E
LE
Morales-Buenrostro
D000328:Adult; D000367:Age Factors; D016736:Antiphospholipid Syndrome / Q000453:epidemiology* / Q000209:etiology; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008181:Lupus Nephritis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D057049:Thrombotic Microangiopathies / Q000453:epidemiology* / Q000209:etiology; D014657:Vasculitis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
D016682:Lupus Coagulation Inhibitor
Arterial sclerosis; lupus nephritis; renal biopsy; systemic lupus erythematosus; thrombotic microangiopathy; vascular