Clinical and morphological correlations in patients with lupus nephritis: a retrospective study
- Authors: Kurginian K.V.1, Stoliarevich E.S.2,3, Litvinova M.A.1, Kokhanchuk V.A.1, Shevchenko S.N.1, Pugach V.A.1, Novikov P.I.1, Moiseev S.V.1,4, Bulanov N.M.1
-
Affiliations:
- Sechenov First Moscow State Medical University (Sechenov University)
- Moscow City Hospital No. 52
- Russian University of Medicine
- Lomonosov Moscow State University
- Issue: Vol 96, No 6 (2024): Нефрология
- Pages: 587-592
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/260071
- DOI: https://doi.org/10.26442/00403660.2024.06.202726
- ID: 260071
Cite item
Full Text
Abstract
Aim. To analyze associations between clinical and morphological features of kidney involvement in patients with systemic lupus erythematosus.
Materials and methods. In the retrospective cohort study, we enrolled adult (≥18 years) patients with morphologically proven lupus nephritis (LN) stratified according to the ISN/RPS classification. Systemic lupus erythematosus was classified in accordance with ACR/EULAR classification criteria (2019). Antiphospholipid syndrome was diagnosed according to the 2006 classification criteria. Disease activity was assessed with SELENA-SLEDAI score.
Results. We enrolled 62 patients with LN, among them 84% were females. Median age of SLE onset was 23 (16,3; 30,8) years. In all cases kidney involvement was accompanied by extrarenal manifestations, among which joint (82%), skin (57%) and hematological involvement (68%) was the most common. LN class I was proven in one patient, class II – in three patients, class III – in 24, including III+V in seven, class IV – in 18, including IV+V in two, class V – in 13, class VI – in three patients. APS nephropathy was diagnosed in 4 (6.5%) of patients with LN. The most common clinical manifestation was proteinuria (85%), however its prevalence, level and the frequency of nephrotic syndrome showed no significant differences between the LN classes. LN III/IV±V was characterized by the highest levels of serum creatinine (and the lowest eGFR) at the time of biopsy.
Conclusion. LN is characterized by the high heterogeneity of the clinical and morphological manifestations, which makes LN class prediction impossible without kidney biopsy.
Full Text
##article.viewOnOriginalSite##About the authors
Kseniia V. Kurginian
Sechenov First Moscow State Medical University (Sechenov University)
Email: nmbulanov@gmail.com
ORCID iD: 0009-0006-6038-7384
ординатор каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского
Russian Federation, MoscowEkaterina S. Stoliarevich
Moscow City Hospital No. 52; Russian University of Medicine
Email: nmbulanov@gmail.com
ORCID iD: 0000-0002-0402-8348
д-р мед. наук, проф. каф. нефрологии, нефролог и патологоанатом Московского городского нефрологического центра
Russian Federation, Moscow; MoscowMariia A. Litvinova
Sechenov First Moscow State Medical University (Sechenov University)
Email: nmbulanov@gmail.com
ORCID iD: 0000-0002-3136-2755
ассистент каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского
Russian Federation, MoscowValeria A. Kokhanchuk
Sechenov First Moscow State Medical University (Sechenov University)
Email: nmbulanov@gmail.com
ORCID iD: 0000-0003-1827-1100
студентка Клинического института детского здоровья им. Н.Ф. Филатова
Russian Federation, MoscowSavely N. Shevchenko
Sechenov First Moscow State Medical University (Sechenov University)
Email: nmbulanov@gmail.com
ORCID iD: 0009-0004-4758-9315
студент Клинического института детского здоровья им. Н.Ф. Филатова
Russian Federation, MoscowValeriia A. Pugach
Sechenov First Moscow State Medical University (Sechenov University)
Email: nmbulanov@gmail.com
ORCID iD: 0009-0004-0430-2177
ординатор каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского
Russian Federation, MoscowPavel I. Novikov
Sechenov First Moscow State Medical University (Sechenov University)
Email: nmbulanov@gmail.com
ORCID iD: 0000-0003-0148-5655
канд. мед. наук, зав. ревматологическим отд-нием Клиники ревматологии, нефрологии и профпатологии им. Е.М. Тареева
Russian Federation, MoscowSergey V. Moiseev
Sechenov First Moscow State Medical University (Sechenov University); Lomonosov Moscow State University
Email: nmbulanov@gmail.com
ORCID iD: 0000-0002-7232-4640
чл.-кор. РАН, д-р мед. наук, проф., зав. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского, дир. Клиники ревматологии, нефрологии и профпатологии им. Е.М. Тареева Университетской клинической больницы №3, проф. каф. внутренних болезней фак-та фундаментальной медицины
Russian Federation, Moscow; MoscowNikolay M. Bulanov
Sechenov First Moscow State Medical University (Sechenov University)
Author for correspondence.
Email: nmbulanov@gmail.com
ORCID iD: 0000-0002-3989-2590
канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского
Russian Federation, MoscowReferences
- Teruel M, Sawalha AH. Epigenetic Variability in Systemic Lupus Erythematosus: What We Learned from Genome-Wide DNA Methylation Studies. Curr Rheumatol Rep. 2017;19(6):32. doi: 10.1007/s11926-017-0657-5
- Giannakakis K, Faraggiana T. Histopathology of lupus nephritis. Clin Rev Allergy Immunol. 2011;40(3):170-80. doi: 10.1007/s12016-010-8207-1
- Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736-45. doi: 10.1136/annrheumdis-2019-215089
- Galindo-Izquierdo M, Rodriguez-Almaraz E, Pego-Reigosa JM, et al. Characterization of Patients With Lupus Nephritis Included in a Large Cohort From the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER). Medicine (Baltimore). 2016;95(9):e2891. doi: 10.1097/MD.0000000000002891
- Moroni G, Vercelloni PG, Quaglini S, et al. Changing patterns in clinical-histological presentation and renal outcome over the last five decades in a cohort of 499 patients with lupus nephritis. Ann Rheum Dis. 2018;77(9):1318-25. doi: 10.1136/annrheumdis-2017-212732
- Бобкова И.Н., Моисеев С.В., Лысенко Л.В., Камышова Е.С. Волчаночный нефрит в XXI в. Терапевтический архив. 2022;94(6):713-7 [Bobkova IN, Moiseev SV, Lysenko LV, Kamyshova ES. Lupus nephritis in the XXI century. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(6):713-7 (in Russian)]. doi: 10.26442/00403660.2022.06.201559
- Mageau A, Timsit JF, Perrozziello A, et al. The burden of chronic kidney disease in systemic lupus erythematosus: A nationwide epidemiologic study. Autoimmun Rev. 2019;18(7):733-7. doi: 10.1016/j.autrev.2019.05.011
- Kidney Disease: Improving Global Outcomes (KDIGO) Lupus Nephritis Work Group. KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS. Kidney Int. 2024;105(1S):S1-S69. doi: 10.1016/j.kint.2023.09.002
- Wang H, Ren YL, Chang J, et al. A Systematic Review and Meta-analysis of Prevalence of Biopsy-Proven Lupus Nephritis. Arch Rheumatol. 2018;33(1):17-25. doi: 10.5606/ArchRheumatol.2017.6127
- Bajema IM, Wilhelmus S, Alpers CE, et al. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int. 2018;93(4):789-96. doi: 10.1016/j.kint.2017.11.023
- Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019;71(9):1400-12. doi: 10.1002/art.40930
- Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306. doi: 10.1111/j.1538-7836.2006.01753.x
- Острое повреждение почек: клинические рекомендации. Режим доступа: https://rusnephrology.org/wp-content/uploads/2020/12/AKI_final.pdf. Ссылка активна на 11.03.2024 [Ostroe povrezhdenie pochek: klinicheskie rekomendatsii. Available at: https://rusnephrology.org/wp-content/uploads/2020/12/AKI_final.pdf. Accessed: 11.03.2024 (in Russian)].
- Croca SC, Rodrigues T, Isenberg DA. Assessment of a lupus nephritis cohort over a 30-year period. Rheumatology (Oxford). 2011;50(8):1424-30. doi: 10.1093/rheumatology/ker101
- Добронравов В.А., Карунная А.В., Сиповский В.Г. Клинико-морфологическая презентация люпус-нефрита (одноцентровое исследование 157 случаев). Нефрология. 2020;24(6):40-54 [Dobronravov VA, Karunnaya AV, Sipovskii VG. Clinical and morphological presentation of lupus nephritis: a single-center study of 157 cases. Nephrology (Saint-Petersburg). 2020;24(6):40-54 (in Russian)]. doi: 10.36485/1561-6274-2020-24-6-40-54
- Hanly JG, O'Keeffe AG, Su L, et al. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford). 2016;55(2):252-62. doi: 10.1093/rheumatology/kev311
- Brevis L, Vargas S, Oddó D, Méndez GP. Clinicopathological correlation among proliferative classes and subclasses of lupus nephritis in renal biopsies. Rev Med Chil. 2019;147(12):1510-7 (in Spanish)]. doi: 10.4067/S0034-98872019001201510
- Gerhardsson J, Sundelin B, Zickert A, et al. Histological antiphospholipid-associated nephropathy versus lupus nephritis in patients with systemic lupus erythematosus: an observational cross-sectional study with longitudinal follow-up. Arthritis Res Ther. 2015;17(1):109. doi: 10.1186/s13075-015-0614-5
- Буланов Н.М., Блюсс О.Б., Мунблит Д.Б., и др. Дизайн научных исследований в медицине. Сеченовский вестник. 2021;12(1):4-17 [Bulanov NM, Blyuss OB, Munblit DB, et al. Studies and research design in medicine. Sechenov Medical Journal. 2021;12(1):4-17 (in Russian)]. doi: 10.47093/2218-7332.2021.12.1.4-17
![](/img/style/loading.gif)