The spectrum of renal diseases with lupus-like features: a single-center study

Abstract

Background A subset of patients without overt systemic lupus erythematosus (SLE) present with biopsy findings typically seen in lupus nephritis (LN). Although a minority eventually develops SLE, many do not. It remains unclear how to classify or treat these patients. Our study attempted to further understand the clinical and pathological characteristics of cases with lupus-like nephritis (LLN). Methods Among 2700 native kidney biopsies interpreted at University of Rochester Medical Center (URMC) from 2010 to 2019, we identified 27 patients with biopsies showing lupus-like features (LL-fx) and 96 with LN. Of those with LL-fx, 17 were idiopathic LLN and 10 were associated with a secondary etiology (e.g., infection/drugs). Results At the time of biopsy, the LLN-group tended to be slightly older (44 vs. 35), male (58.8 vs. 17.7%, p = .041), and Caucasian (47.0 vs. 28.1%, p = .005). Chronic kidney disease was the most common biopsy indication in LLN (21.4 vs. 2.8%, p = .001). Both LN and LLN presented with nephrotic-range proteinuria (mean 5.73 vs . 4.40 g/d), and elevated serum creatinine (mean 1.66 vs . 1.47 mg/dL). Tubuloreticular inclusions (TRIs; p < .001) and fibrous crescents ( p = .04) were more often seen in LN, while more tubulointerstitial scarring was seen in LLN ( p = .011). At mean follow-up of 1684 d (range: 31–4323), none of the LLN patients developed ESRD. A subset of both LN and cases with LL-fx overlapped with other autoimmune diseases. Conclusions Lupus-like pathologic features are seen in a wide array of disease processes. The findings suggest that LLN may be a manifestation of an autoimmune process that overlaps with SLE.

Nonlupus Full House Nephropathy

“…• Intensity of stainings on scale from 0 -3 groups, 3,21,28 idiopathic nonlupus full house nephropathy was an independent risk factor for ESKD in ISN/RPS 14 class III and IV patients according to Rijnink et al 11 However, despite a comparable number of patients receiving immunosuppression, no one had received cytotoxic therapy in the latter study. Different use of immunosuppression may justify the contrasting results, supporting the idea that immunosuppressive therapy could be beneficial for this group.…”

The predictive value of fibrinogen‐to‐albumin ratio in the active, severe active, and poor prognosis of systemic lupus erythematosus: A single‐center retrospective study

“…Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, 1 often coexists with other diseases, which has a broad range of clinical presentations with variable disease courses, and damages multiple organs, such as kidney, liver, nervous system, and so on. 2,3 SLE differs between genders, with women affected nine times more frequently than men. 4 Although there is no consensus on the etiology and pathogenesis of SLE, contributing factors of SLE development are closely related to genetics, autoimmune system abnormalities, endocrine hormone disorders, external environment, and other factors.…”

“…Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, 1 often coexists with other diseases, which has a broad range of clinical presentations with variable disease courses, and damages multiple organs, such as kidney, liver, nervous system, and so on 2,3 . SLE differs between genders, with women affected nine times more frequently than men 4 .…”