Chao-Yi Wu1, Hui-Ping Chien2, Huang-Yu Yang3, Tsung-Chieh Yao1, Min-Hua Tseng4, Mei-Chin Yu4, Kuo-Wei Yeh1, Jing-Long Huang5. 1. Division of Allergy, Asthma, and Rheumatology, Chang Gung Children's Hospital, Taoyuan, Taiwan, ROC; Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC. 2. Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC; Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC. 3. Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC; Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC. 4. Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC; Division of Pediatric Nephrology, Chang Gung Children's Hospital, Taoyuan, Taiwan, ROC. 5. Division of Allergy, Asthma, and Rheumatology, Chang Gung Children's Hospital, Taoyuan, Taiwan, ROC; Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC. Electronic address: long@adm.cgmh.org.tw.
Abstract
BACKGROUND: Raising evidence suggested a prognostic utility of tubulointerstitial lesions in lupus nephritis (LN). The exact prevalence of tubulointerstitial abnormalities and its predictive value among pediatric onset systemic lupus erythematous (pSLE) cases, however, remained unknown. METHODS: Sixty-seven pSLE subjects diagnosed with LN with initial renal samples available were enrolled and followed for an average of 6.49 ± 3.06 years. Renal histology was evaluated according to the International Society of Nephrology/Renal Pathology Society classification, National Institute of Health classification and tubulointerstitial activity index (TIAI). RESULTS: Tubulointerstitial injuries were observed in 38.81% of all LN cases, including 13.33% with non-proliferative lupus nephritis (nPLN) and 46.15% of with proliferative lupus nephritis (PLN). Tubulointerstitial injuries occurred solitarily in cases with nPLN(13.33%), but always associated glomerular changes and significantly impacted renal survival (p = 0.032) among those with PLN. TIAI associated glomerular abnormalities (p = 0.031) but did not correlate renal performance or subsequent outcome (p = 0.445). Among the chronicity index, it was the chronic tubulointerstitial lesions that provided prognostic information (p = 0.012). None of the individual tubulointerstitial factors, however, reached statistical significance in end-stage renal disease prediction. Finally, considering tubulointerstitial injuries in PLN further discriminated subsequent renal outcome (p = 0.006). CONCLUSION: Tubulointerstitial abnormalities were found in nearly one-third of all pediatric LN cases. With its importance in early identifying those at risk of renal failure, histologic classification considering tubulointerstitial lesions may potentially assist outcome prediction.
BACKGROUND: Raising evidence suggested a prognostic utility of tubulointerstitial lesions in lupus nephritis (LN). The exact prevalence of tubulointerstitial abnormalities and its predictive value among pediatric onset systemic lupus erythematous (pSLE) cases, however, remained unknown. METHODS: Sixty-seven pSLE subjects diagnosed with LN with initial renal samples available were enrolled and followed for an average of 6.49 ± 3.06 years. Renal histology was evaluated according to the International Society of Nephrology/Renal Pathology Society classification, National Institute of Health classification and tubulointerstitial activity index (TIAI). RESULTS: Tubulointerstitial injuries were observed in 38.81% of all LN cases, including 13.33% with non-proliferative lupus nephritis (nPLN) and 46.15% of with proliferative lupus nephritis (PLN). Tubulointerstitial injuries occurred solitarily in cases with nPLN(13.33%), but always associated glomerular changes and significantly impacted renal survival (p = 0.032) among those with PLN. TIAI associated glomerular abnormalities (p = 0.031) but did not correlate renal performance or subsequent outcome (p = 0.445). Among the chronicity index, it was the chronic tubulointerstitial lesions that provided prognostic information (p = 0.012). None of the individual tubulointerstitial factors, however, reached statistical significance in end-stage renal disease prediction. Finally, considering tubulointerstitial injuries in PLN further discriminated subsequent renal outcome (p = 0.006). CONCLUSION:Tubulointerstitial abnormalities were found in nearly one-third of all pediatric LN cases. With its importance in early identifying those at risk of renal failure, histologic classification considering tubulointerstitial lesions may potentially assist outcome prediction.
Authors: Lu Zhang; Mengqin Zhang; Xing Chen; Yan He; Rongjuan Chen; Jun Zhang; Jiyi Huang; Chun Ouyang; Guixiu Shi Journal: Ann Transl Med Date: 2020-12
Authors: Myrto Kostopoulou; Antonis Fanouriakis; Kim Cheema; John Boletis; George Bertsias; David Jayne; Dimitrios T Boumpas Journal: RMD Open Date: 2020-07