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Article: Clinical Outcomes and Clinico-pathological Correlations in Lupus Nephritis with Kidney Biopsy Showing Thrombotic Microangiopathy

TitleClinical Outcomes and Clinico-pathological Correlations in Lupus Nephritis with Kidney Biopsy Showing Thrombotic Microangiopathy
Authors
KeywordsLupus nephritis
Outcomes
Thrombotic microangiopathy
Issue Date2019
PublisherJournal of Rheumatology Publishing Co Ltd. The Journal's web site is located at http://www.jrheum.com
Citation
Journal of Rheumatology, 2019, article no. 180773 How to Cite?
AbstractObjective: 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.
Persistent Identifierhttp://hdl.handle.net/10722/272562
ISSN
2023 Impact Factor: 3.6
2023 SCImago Journal Rankings: 1.128
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLi, C-
dc.contributor.authorYap, DY-
dc.contributor.authorChan, G-
dc.contributor.authorWen, YB-
dc.contributor.authorLi, H-
dc.contributor.authorTang, CSO-
dc.contributor.authorLi, XM-
dc.contributor.authorLi, XW-
dc.contributor.authorChan, DTM-
dc.date.accessioned2019-07-23T03:21:07Z-
dc.date.available2019-07-23T03:21:07Z-
dc.date.issued2019-
dc.identifier.citationJournal of Rheumatology, 2019, article no. 180773-
dc.identifier.issn0315-162X-
dc.identifier.urihttp://hdl.handle.net/10722/272562-
dc.description.abstractObjective: 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.-
dc.languageeng-
dc.publisherJournal of Rheumatology Publishing Co Ltd. The Journal's web site is located at http://www.jrheum.com-
dc.relation.ispartofJournal of Rheumatology-
dc.subjectLupus nephritis-
dc.subjectOutcomes-
dc.subjectThrombotic microangiopathy-
dc.titleClinical Outcomes and Clinico-pathological Correlations in Lupus Nephritis with Kidney Biopsy Showing Thrombotic Microangiopathy-
dc.typeArticle-
dc.identifier.emailYap, DY: desmondy@hku.hk-
dc.identifier.emailChan, G: chanswg@hkucc.hku.hk-
dc.identifier.emailTang, CSO: csotang@hkucc.hku.hk-
dc.identifier.emailChan, DTM: dtmchan@hku.hk-
dc.identifier.authorityYap, DY=rp01607-
dc.identifier.authorityChan, DTM=rp00394-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.3899/jrheum.180773-
dc.identifier.pmid30877215-
dc.identifier.scopuseid_2-s2.0-85074378494-
dc.identifier.hkuros299781-
dc.identifier.spagearticle no. 180773-
dc.identifier.epagearticle no. 180773-
dc.identifier.isiWOS:000493976000010-
dc.publisher.placeCanada-
dc.identifier.issnl0315-162X-

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