Chao Li1,2, Desmond Y H Yap1,2, Gavin Chan1,2, Yu-Bing Wen1,2, Hang Li1,2, Colin Tang1,2, Xue-Mei Li3,4, Xue-Wang Li1,2, Tak Mao Chan3,4. 1. From the Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong; Department of Pathology, Queen Mary Hospital, Hong Kong. 2. C. Li, MD, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; D.Y. Yap, MBBS, MD, Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong; G. Chan, MBBS, Department of Pathology, Queen Mary Hospital; Y.B. Wen, MMed, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; H. Li, MD, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; C. Tang, BSc, MSc, Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong; X.M. Li, MD, PhD, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; X.W. Li, MMed, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; T.M. Chan, MBBS, MD, Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong. CL and DYY contributed equally to this work. 3. From the Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong; Department of Pathology, Queen Mary Hospital, Hong Kong. dtmchan@hku.hk lixmpumch@126.com. 4. C. Li, MD, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; D.Y. Yap, MBBS, MD, Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong; G. Chan, MBBS, Department of Pathology, Queen Mary Hospital; Y.B. Wen, MMed, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; H. Li, MD, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; C. Tang, BSc, MSc, Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong; X.M. Li, MD, PhD, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; X.W. Li, MMed, Division of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; T.M. Chan, MBBS, MD, Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong. CL and DYY contributed equally to this work. dtmchan@hku.hk lixmpumch@126.com.
Abstract
OBJECTIVE: Renal thrombotic microangiopathy (TMA) is an uncommon pathological finding in lupus nephritis (LN), and its clinical significance remains to be defined. METHODS: Twenty-four patients with lupus nephritis (LN) and renal TMA were selected from a retrospective review of 677 biopsy-proven LN patients, and compared with 48 LN controls without TMA (1:2 ratio) matched according to demographics and treatments. RESULTS: Renal TMA was noted in 3.5% of kidney biopsies of LN. TMA was associated with a higher prevalence of anti-Ro (45.8% vs 18.8%; p = 0.016), higher Systemic Lupus Erythematosus Disease Activity Index scores (21.4 ± 8.5 vs 10.8 ± 2.3; p < 0.001), lower estimated glomerular filtration rate (eGFR; 16.8 ± 11.7 ml/min vs 77.8 ± 28.6 ml/min; p < 0.001), and a higher percentage of patients who required dialysis (37.5% vs 2.1%; p < 0.001) at the time of kidney biopsy. Activity and chronicity indices [median (range)] were higher in the TMA group [11 (2-19) and 3 (1-8), respectively, compared with 7 (0-15) and 1 (0-3) in controls; p = 0.004 and p < 0.001; respectively]. Patients with TMA showed inferior 5-year renal survival and higher incidence of chronic kidney disease at last followup (70% and 66.6%, respectively, compared with 95% and 29.2% in controls; p = 0.023 and 0.002, respectively). The TMA group also showed lower median eGFR compared with controls [50.1 (IQR 7-132) ml/min vs 85.0 (IQR 12-147) ml/min; p = 0.003]. Five-year patient survival rate was similar between the 2 groups (87% and 98% in TMA and control group, respectively; p = 0.127). CONCLUSION: TMA in kidney biopsy was associated with more severe clinical and histological activity, and significantly inferior longterm renal outcome in LN.
OBJECTIVE:Renal thrombotic microangiopathy (TMA) is an uncommon pathological finding in lupus nephritis (LN), and its clinical significance remains to be defined. METHODS: Twenty-four patients with lupus nephritis (LN) and renal TMA were selected from a retrospective review of 677 biopsy-proven LN patients, and compared with 48 LN controls without TMA (1:2 ratio) matched according to demographics and treatments. RESULTS:Renal TMA was noted in 3.5% of kidney biopsies of LN. TMA was associated with a higher prevalence of anti-Ro (45.8% vs 18.8%; p = 0.016), higher Systemic Lupus Erythematosus Disease Activity Index scores (21.4 ± 8.5 vs 10.8 ± 2.3; p < 0.001), lower estimated glomerular filtration rate (eGFR; 16.8 ± 11.7 ml/min vs 77.8 ± 28.6 ml/min; p < 0.001), and a higher percentage of patients who required dialysis (37.5% vs 2.1%; p < 0.001) at the time of kidney biopsy. Activity and chronicity indices [median (range)] were higher in the TMA group [11 (2-19) and 3 (1-8), respectively, compared with 7 (0-15) and 1 (0-3) in controls; p = 0.004 and p < 0.001; respectively]. Patients with TMA showed inferior 5-year renal survival and higher incidence of chronic kidney disease at last followup (70% and 66.6%, respectively, compared with 95% and 29.2% in controls; p = 0.023 and 0.002, respectively). The TMA group also showed lower median eGFR compared with controls [50.1 (IQR 7-132) ml/min vs 85.0 (IQR 12-147) ml/min; p = 0.003]. Five-year patient survival rate was similar between the 2 groups (87% and 98% in TMA and control group, respectively; p = 0.127). CONCLUSION:TMA in kidney biopsy was associated with more severe clinical and histological activity, and significantly inferior longterm renal outcome in LN.
Authors: David Massicotte-Azarniouch; Elizabeth Kotzen; Sarah Todd; Yichun Hu; Susan L Hogan; Koyal Jain Journal: Lupus Date: 2022-06-01 Impact factor: 2.858
Authors: Precil Diego Miranda de Menezes Neves; Rafael A Souza; Fábio M Torres; Fábio A Reis; Rafaela B Pinheiro; Cristiane B Dias; Luis Yu; Viktoria Woronik; Luzia S Furukawa; Lívia B Cavalcante; Stanley de Almeida Araújo; David Campos Wanderley; Denise M Malheiros; Lectícia B Jorge Journal: PLoS One Date: 2020-11-04 Impact factor: 3.240