A case of lupus vasculopathy presenting favorable renal outcome

Abstract

Noninflammatory necrotizing vasculopathy, also referred to as lupus vasculopathy, is not infrequently observed in the pathology of lupus nephritis. It affects vessels causing them to become severely narrowed and occluded by a mechanism involving immune complexes. We experienced a 51-year-old woman with lupus nephritis class IV + V, which was accompanied by lupus vasculopathy. Renal biopsy and light microscopy showed eosinophilic hyaline-like material in the afferent and/or efferent arterioles, which narrowed the lumen, and which were positive for IgG by immunofluorescent analysis. Electron microscopy indicated that amorphous material and endothelial detachment occluded the arterioles. These findings were consistent with those of lupus vasculopathy. We treated the patient with steroids and cyclophosphamide. By the day of discharge, her levels of creatinine and proteinuria had undergone partial remission. Although lupus vasculopathy was implied as a lesion with unfavorable renal prognosis, some recent reports suggest its true renal prognosis is not unfavorable necessarily. Nevertheless, lupus vasculopathy is an important finding in diagnosis in contradiction to other vascular legions in systemic lupus erythematosus. In addition, a standard therapy has also not been established. Therefore, it is important to accumulate cases of lupus vasculopathy to determine its prognosis and develop standard treatments.

Modified arteriosclerosis score predicts the outcomes of diabetic kidney disease

“…With respect to the first research question, we found that the proportion of severe arteriosclerosis was an independent predictor of clinical progression to ESRD for DKD patients. In lupus nephritis and IgA nephropathy, some studies have supported vascular lesions as independent risk factors for predicting renal disease progression [ 32 – 35 ]. Although the pathological classification of DKD included the vascular score in the original literature, the authors did not validate the relationship between vascular lesions and renal prognosis [ 12 ].…”

Connexin 43 Expression in Cutaneous Biopsies of Lupus Erythematosus

“…39 Eventually, immune complex deposits can cause blood vessel narrowing and occlusion, driving the lupus-related vasculopathy. 40 However, although blood vessels are so important in LE, the role of endothelial alteration in LE is far from being completely understood. Somehow, the immune system dysfunction contributes to vascular dysfunction in systemic LE, 41 which triggers most clinical manifestations of the disease.…”