Kidney Biopsy and Immuno-Rheumatological Diseases: A Retrospective and Observational Study

Abstract

Renal involvement is a common occurrence in patients with immuno-rheumatological diseases (IRDs). Several instances of glomerulonephritis (GN) occur in the setting of IRD and complicate the clinical course of an underlying condition. The aim of this study was to observe the spectrum of nephropathies according to age, kidney function, history of IRD at the time of biopsy, and histopathological kidney diagnosis. We evaluated data relating to 699 consecutive kidney native biopsies (female 52.1%) with a median age of 48 years (IQR 34-62) performed in adult patients collected over 15 years. The study population was divided into three groups: patients with kidney histological findings correlated to underlying IRD (Group 1), patients with kidney histological findings not correlated to underlying IRD (Group 2), and patients with kidney histological findings compatible with "de novo" IRD (absent in personal medical history) (Group 3). Kidney involvement related to IRD was found in 25.2% of patients. Group 1 was mostly represented by lupus nephritis (76.6%), with a younger age than Group 3 (p < 0.001) and by a higher percentage of females than other groups (p < 0.001). Group 3 was the most represented by microscopic polyangiitis (50.8%) when compared with the other two groups (p < 0.001). Acute nephritic syndrome (p < 0.001), acute kidney injury (AKI), and abnormal urinalysis (p < 0.001) were more represented in Group 3 than the other groups. In conclusion, IRDs are characterized by different clinical presentations and heterogeneous histological findings. Kidney biopsy remains fundamental to achieving the correct diagnosis and starting targeted therapy.

Keywords: autoimmunity; glomerulonephritis; immuno-rheumatological diseases; kidney biopsy; lupus nephritis; vasculitis.

Figure 1

Comparison of the study population split into three groups. (A): age; (B): serum creatinine; (C): eGFR; (D): blood urea levels. Group 1: kidney histological correlated to IRD known at the time of biopsy. Group 2: kidney histological findings not correlated to IRD known at the time of biopsy. Group 3: “de novo” IRD not present in medical history at the time of biopsy. *** p < 0.001. IRD: immuno-rheumatological disease. eGFR: estimated glomerular filtration rate. circles and asterisks are outliers.

Figure 2

Proliferative extracapillary glomerulonephritis with the formation of a crescentic cell in the lower part of the glomerulus in microscopic polyangiitis (PAS). ×100.