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5 Impact of vascular involvement on outcomes in patients with lupus nephritis
  1. M Rathi1,
  2. H Prasad1,
  3. A Sharma2,
  4. R Nada3 and
  5. KL Gupta1
  1. 1Postgraduate Institute of Medical Education and Research, Nephrology, Chandigarh, India
  2. 2Postgraduate Institute of Medical Education and Research, Internal Medicine, Chandigarh, India
  3. 3Postgraduate Institute of Medical Education and Research, Histopathology, Chandigarh, India

Abstract

Background and aims The exact incidence and significance of vascular involvement (VI) in patients of lupus nephritis (LN) is not clear.

Methods All renal biopsy confirmed LN cases over a five years were included. The biopsy was reviewed and subjects were divided into two subgroups: Group 1 (VI present), and Group 2 (VI absent). Morphological lesions of lupus vasculopathy, vascular thrombotic microangiopathy (TMA), vasculitis, vascular immune deposits and arteriosclerosis were taken as VI. Clinical details and treatment received were noted and the outcomes were assessed at the end of six months.

Results A total of 241 biopsy proven LN patients (211 females, 30 males) with mean age of 29.79±9.44 years were included. The VI was seen in 78 patients (32.3%, Group 1). Vascular immune deposits was seen in 13 (5.3%), lupus vasculopathy in 5 (2.0%), vasculitis in 2 (0.8%), vascular TMA in 27 (11.2%) and arteriosclerosis in 55 (22.8%) patients. There was no difference between the two groups at baseline, except for a higher serum creatinine in Group 1 (1.87 vs 1.43 mg/dL, p=0.004). At the end of six months of treatment, Group 1 patients had higher 24 hour protein excretion (1.10±1.64 vs 0.88±2.23 gms/day, p=0.001) and higher serum creatinine (1.35±1.25 vs 0.92±0.56 mg/dL, p=0.001). 38.2% patients in Group 1 achieved complete remission as compared to 61.9% in Group 2 (p=0.006), while, 26.3% patients in Group 1 had resistant disease as compared to 14.3% in Group 2 (p=0.02).

Conclusions LN patients with VI have more severe renal presentation and poorer outcomes.

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