Renal histopathology predicts kidney failure, death in patients with lupus nephritis

Histologic variables of renal biopsy in lupus nephritis (LN) are significantly associated with kidney failure and mortality, suggests a recent study.

Overall, 256 patients with LN were enrolled between 2006 and 2019 in this study. The authors classified renal pathology according to the International Society of Nephrology/Renal Pathology Society classification. They then analysed the components of activity and chronicity indices to determine which variables predicted an increased risk of kidney failure and death, with adjustments for confounders.

Of the participants, 58 progressed to kidney failure and 64 died during a median follow-up period of 7.5 years. Multivariate analysis revealed that tubular atrophy (hazard ratio [HR], 2.28, 95 percent confidence interval [CI], 1.66‒3.14) and tubulointerstitial inflammation (HR, 3.13, 95 percent CI, 1.34‒7.33) were significantly associated with kidney failure.

In addition, renal outcomes could be worse if tubular atrophy and tubulointerstitial inflammation were both present (10-year kidney survival rate, 63.22 percent).

Notably, the presence of cellular crescents was predictive of death in male patients with LN (HR, 1.91, 95 percent CI, 1.02‒3.57), while the presence of fibrous crescents correlated with an increased risk of death in female patients with LN (HR, 5.70, 95 percent CI, 1.61‒20.25).

“LN, a common manifestation of systemic lupus erythematosus, is associated with a higher risk of kidney failure and death,” the authors said. “The renal pathology of LN helps elucidate the severity of inflammation and the extent of irreversible damage.”