The Association between Pathologic Features from Renal Biopsies and End-Stage Renal Disease in Lupus Nephritis Patients Open Access

Patel, Deesha (2012)

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Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease.
SLE can potentially be fatal, especially when major organs are affected. About two-thirds
of SLE patients may develop inflammation of the kidneys, or lupus nephritis. Lupus
nephritis can progress to end-stage renal disease (ESRD), which requires dialysis or renal
transplant. Lupus nephritis is currently classified through pathologic features from renal
biopsies, which are categorized by the World Health Organization (WHO) morphologic
classification of lupus nephritis (1995) or the International Society of Nephrology/Renal
Pathology Society Classification (ISN/RPS) of Lupus Nephritis (2003). The aim of this
study was to determine the association between pathologic findings from renal biopsies
and ESRD in lupus nephritis patients, as well as to determine if the WHO classification
of proliferative lupus nephritis was associated with ESRD.
Methods: 237 patients were selected from the Georgia Lupus Registry, a population-
based registry of diagnosed SLE in metropolitan Atlanta. Inclusion criteria included
validated diagnosis of SLE, a pathology report of an abnormal renal biopsy (WHO
classes II-V), ESRD diagnosis after renal biopsy, and African American or White race.
Final predictors, and potential confounders, were determined based on previous research
and clinical relevance; proliferative lupus nephritis was determined using WHO
classification. Univariate and multivariate analyses were conducted to determine if
pathologic features and proliferative lupus nephritis were associated with ESRD.
Results: The final predictors of interstitial damage, glomerular damage, greater than 25%
glomeruli sclerosed, arteriosclerosis or arteriolosclerosis, and tubuloreticular bodies
combined were predictive of ESRD (aOR = 8.73, 95% CI: 1.19, 63.76). Glomerular
damage and greater than 25% glomeruli sclerosed were statistically significantly
associated with ESRD in univariate and multivariate analyses; tubuloreticular bodies
were a statistically significant protective factor for ESRD in both analyses. Proliferative
lupus nephritis was not associated with ESRD in either analysis, producing almost a null
Conclusion: When combined together, the selected pathologic features were greatly
associated with ESRD. However, only half of those features were associated with ESRD
individually. Proliferative lupus nephritis was not associated with ESRD. This study
indicates the potential of pathologic features in predicting ESRD in lupus nephritis

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