Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb;47(4):545-551.
doi: 10.1016/j.semarthrit.2017.07.007. Epub 2017 Jul 14.

Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study

Anna Broder  1 , Wenzhu B Mowrey  2 , Hina N Khan  3 , Bojana Jovanovic  4 , Alejandra Londono-Jimenez  3 , Peter Izmirly  5 , Chaim Putterman  4
Affiliations

Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study

Anna Broder et al. Semin Arthritis Rheum. 2018 Feb.

Abstract

Objectives: The presence of tubulointerstitial damage (TID) on renal biopsy is considered to be a late sequela of lupus nephritis (LN). The objective of this study was to determine if TID predicts progression to end stage renal disease (ESRD) in LN patients without advanced kidney disease.

Methods: All SLE patients with an index biopsy consistent with LN between January 2005 and July 2015, and eGFR ≥ 30mL/min/1.73m2 were included. Moderate-to-severe TID was defined as the presence of moderate-to-severe tubular atrophy and/or interstitial fibrosis. Time to ESRD was defined as time from the index biopsy date to incident ESRD date; non-ESRD patients were censored at the time of death or the last visit before December 2015. Time-dependent analyses were conducted to evaluate whether moderate-to-severe TID was predictive of ESRD progression.

Results: Of the 131 LN patients with eGFR ≥ 30mL/min/1.73m2, 17 (13%) patients progressed to ESRD. Moderate-to-severe TID was present in 13% of biopsies with eGFR ≥ 60mL/min/1.73m2 and in 33% of biopsies with eGFR between 30 and 60mL/min/1.73m2. Moderate-to-severe TID was associated with a higher risk of ESRD progression: adjusted hazard ratio (HR) = 4.1, 95% CI: 1.4-12.1, p = 0.01 for eGFR ≥ 30mL/min/1.73m2; HR = 6.2, 95% CI: 1.7-23.2, p = 0.008 for eGFR ≥ 60mL/min/1.73m2. There was no association between tubulointerstitial inflammation (TII) and ESRD progression.

Conclusions: Moderate-to-severe TID, but not TII, was a strong predictor of ESRD progression independent of eGFR or glomerular findings, therefore, providing an important window for potential early interventions.

Keywords: End stage renal disease; Lupus nephritis; Tubulointerstitial damage.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest:

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Inclusion/Exclusion Abbreviations GFR: glomerular filtration rate TID: tubulointerstital damage TII: tubulointerstitial inflammation LN: lupus nephritis
Figure 2
Figure 2
Kaplan-Meier Survival Curves for ESRD Progression in Patients with eGFR>30 mL/min/1.73m2 by the Severity of TID
See this image and copyright information in PMC

References

    1. Costenbader KH, Desai A, Alarcon GS, et al. Trends in the incidence, demographics, and outcomes of end-stage renal disease due to lupus nephritis in the US from 1995 to 2006. Arthritis and rheumatism. 2011;63(6):1681–8. - PMC - PubMed
    1. Hanly JG, O’Keeffe AG, Su L, et al. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology. 2016;55(2):252–62. - PMC - PubMed
    1. Weening JJ, D’Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney international. 2004;65(2):521–30. - PubMed
    1. Hiramatsu N, Kuroiwa T, Ikeuchi H, et al. Revised classification of lupus nephritis is valuable in predicting renal outcome with an indication of the proportion of glomeruli affected by chronic lesions. Rheumatology. 2008;47(5):702–7. - PubMed
    1. Mittal B, Hurwitz S, Rennke H, Singh AK. New subcategories of class IV lupus nephritis: are there clinical, histologic, and outcome differences? American journal of kidney diseases : the official journal of the National Kidney Foundation. 2004;44(6):1050–9. - PubMed

Publication types