Evaluation of clinical outcomes and renal vascular pathology among patients with lupus

Claire Barber, Andrew Herzenberg, Ellie Aghdassi, Jiandong Su, Wendy Lou, Gan Qian, Jonathan Yip, Samih H. Nasr, David Thomas, James W. Scholey, Joan Wither, Murray Urowitz, Dafna Gladman, Heather Reich, Paul R. Fortin

Research output: Contribution to journalArticle

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Abstract

Background and objectives The objective of this study was to determine the clinical significance of renal vascular lesions in lupus nephritis. Design, setting, participants, & measurements Renal vascular lesions defined as thrombotic microangiopathy, lupus vasculopathy, uncomplicated vascular immune deposits, and arterial sclerosis were evaluated in relation to renal and vascular morbidity and overall mortality. Results Biopsies from 161 patients revealed thrombotic microangiopathy (13), lupus vasculopathy (5), and arterial sclerosis (93). No renal vascular lesions were found in 24.8% of patients. At the time of biopsy, arterial sclerosis or lupus vasculopathy patients were older (arterial sclerosis=37.9±13.0 and lupus vasculopathy=44.4±8.9 versus controls=33.1±8.9 years, P,0.05), and the mean arterial pressurewas higher in all groups compared with controls. Nephritis subtype, activity indices, and proteinuria were similar between groups, estimated GFR was lower in arterial sclerosis (70.5±33.3 versus 84.5±26.6 ml/min per 1.73 m 2, P=0.03), and chronicity index (thrombotic microangiopathy=3.5, lupus vasculopathy=4.5, and arterial sclerosis=2.5) was higher in all renal vascular lesions subgroups versus controls (1.0, P,0.05). In 133 patientswith similar follow-up, the association between renal vascular lesions and vascular eventswas significant (Fisher exact test, P=0.002) and remained so after multivariate analysis (exact conditional scores test, P=0.04), where the difference between arterial sclerosis and uncomplicated vascular immune deposits was most noticeable (odds ratio [95% confidence interval]=8.35[0.98, 83.12], P=0.05). The associations between renal vascular lesions, renal outcomes, and death were not significant, likely because of insufficient power. Conclusions Renal vascular lesions are common in SLE patients with nephritis and may be associated with arterial vascular events.

Original languageEnglish (US)
Pages (from-to)757-764
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume7
Issue number5
DOIs
StatePublished - May 1 2012

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Blood Vessels
Pathology
Kidney
Sclerosis
Thrombotic Microangiopathies
Nephritis
Biopsy
Lupus Nephritis
Proteinuria
Multivariate Analysis
Odds Ratio
Confidence Intervals
Morbidity
Mortality

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Evaluation of clinical outcomes and renal vascular pathology among patients with lupus. / Barber, Claire; Herzenberg, Andrew; Aghdassi, Ellie; Su, Jiandong; Lou, Wendy; Qian, Gan; Yip, Jonathan; Nasr, Samih H.; Thomas, David; Scholey, James W.; Wither, Joan; Urowitz, Murray; Gladman, Dafna; Reich, Heather; Fortin, Paul R.

In: Clinical Journal of the American Society of Nephrology, Vol. 7, No. 5, 01.05.2012, p. 757-764.

Research output: Contribution to journalArticle

Barber, C, Herzenberg, A, Aghdassi, E, Su, J, Lou, W, Qian, G, Yip, J, Nasr, SH, Thomas, D, Scholey, JW, Wither, J, Urowitz, M, Gladman, D, Reich, H & Fortin, PR 2012, 'Evaluation of clinical outcomes and renal vascular pathology among patients with lupus', Clinical Journal of the American Society of Nephrology, vol. 7, no. 5, pp. 757-764. https://doi.org/10.2215/CJN.02870311
Barber, Claire ; Herzenberg, Andrew ; Aghdassi, Ellie ; Su, Jiandong ; Lou, Wendy ; Qian, Gan ; Yip, Jonathan ; Nasr, Samih H. ; Thomas, David ; Scholey, James W. ; Wither, Joan ; Urowitz, Murray ; Gladman, Dafna ; Reich, Heather ; Fortin, Paul R. / Evaluation of clinical outcomes and renal vascular pathology among patients with lupus. In: Clinical Journal of the American Society of Nephrology. 2012 ; Vol. 7, No. 5. pp. 757-764.
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abstract = "Background and objectives The objective of this study was to determine the clinical significance of renal vascular lesions in lupus nephritis. Design, setting, participants, & measurements Renal vascular lesions defined as thrombotic microangiopathy, lupus vasculopathy, uncomplicated vascular immune deposits, and arterial sclerosis were evaluated in relation to renal and vascular morbidity and overall mortality. Results Biopsies from 161 patients revealed thrombotic microangiopathy (13), lupus vasculopathy (5), and arterial sclerosis (93). No renal vascular lesions were found in 24.8{\%} of patients. At the time of biopsy, arterial sclerosis or lupus vasculopathy patients were older (arterial sclerosis=37.9±13.0 and lupus vasculopathy=44.4±8.9 versus controls=33.1±8.9 years, P,0.05), and the mean arterial pressurewas higher in all groups compared with controls. Nephritis subtype, activity indices, and proteinuria were similar between groups, estimated GFR was lower in arterial sclerosis (70.5±33.3 versus 84.5±26.6 ml/min per 1.73 m 2, P=0.03), and chronicity index (thrombotic microangiopathy=3.5, lupus vasculopathy=4.5, and arterial sclerosis=2.5) was higher in all renal vascular lesions subgroups versus controls (1.0, P,0.05). In 133 patientswith similar follow-up, the association between renal vascular lesions and vascular eventswas significant (Fisher exact test, P=0.002) and remained so after multivariate analysis (exact conditional scores test, P=0.04), where the difference between arterial sclerosis and uncomplicated vascular immune deposits was most noticeable (odds ratio [95{\%} confidence interval]=8.35[0.98, 83.12], P=0.05). The associations between renal vascular lesions, renal outcomes, and death were not significant, likely because of insufficient power. Conclusions Renal vascular lesions are common in SLE patients with nephritis and may be associated with arterial vascular events.",
author = "Claire Barber and Andrew Herzenberg and Ellie Aghdassi and Jiandong Su and Wendy Lou and Gan Qian and Jonathan Yip and Nasr, {Samih H.} and David Thomas and Scholey, {James W.} and Joan Wither and Murray Urowitz and Dafna Gladman and Heather Reich and Fortin, {Paul R.}",
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AU - Barber, Claire

AU - Herzenberg, Andrew

AU - Aghdassi, Ellie

AU - Su, Jiandong

AU - Lou, Wendy

AU - Qian, Gan

AU - Yip, Jonathan

AU - Nasr, Samih H.

AU - Thomas, David

AU - Scholey, James W.

AU - Wither, Joan

AU - Urowitz, Murray

AU - Gladman, Dafna

AU - Reich, Heather

AU - Fortin, Paul R.

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N2 - Background and objectives The objective of this study was to determine the clinical significance of renal vascular lesions in lupus nephritis. Design, setting, participants, & measurements Renal vascular lesions defined as thrombotic microangiopathy, lupus vasculopathy, uncomplicated vascular immune deposits, and arterial sclerosis were evaluated in relation to renal and vascular morbidity and overall mortality. Results Biopsies from 161 patients revealed thrombotic microangiopathy (13), lupus vasculopathy (5), and arterial sclerosis (93). No renal vascular lesions were found in 24.8% of patients. At the time of biopsy, arterial sclerosis or lupus vasculopathy patients were older (arterial sclerosis=37.9±13.0 and lupus vasculopathy=44.4±8.9 versus controls=33.1±8.9 years, P,0.05), and the mean arterial pressurewas higher in all groups compared with controls. Nephritis subtype, activity indices, and proteinuria were similar between groups, estimated GFR was lower in arterial sclerosis (70.5±33.3 versus 84.5±26.6 ml/min per 1.73 m 2, P=0.03), and chronicity index (thrombotic microangiopathy=3.5, lupus vasculopathy=4.5, and arterial sclerosis=2.5) was higher in all renal vascular lesions subgroups versus controls (1.0, P,0.05). In 133 patientswith similar follow-up, the association between renal vascular lesions and vascular eventswas significant (Fisher exact test, P=0.002) and remained so after multivariate analysis (exact conditional scores test, P=0.04), where the difference between arterial sclerosis and uncomplicated vascular immune deposits was most noticeable (odds ratio [95% confidence interval]=8.35[0.98, 83.12], P=0.05). The associations between renal vascular lesions, renal outcomes, and death were not significant, likely because of insufficient power. Conclusions Renal vascular lesions are common in SLE patients with nephritis and may be associated with arterial vascular events.

AB - Background and objectives The objective of this study was to determine the clinical significance of renal vascular lesions in lupus nephritis. Design, setting, participants, & measurements Renal vascular lesions defined as thrombotic microangiopathy, lupus vasculopathy, uncomplicated vascular immune deposits, and arterial sclerosis were evaluated in relation to renal and vascular morbidity and overall mortality. Results Biopsies from 161 patients revealed thrombotic microangiopathy (13), lupus vasculopathy (5), and arterial sclerosis (93). No renal vascular lesions were found in 24.8% of patients. At the time of biopsy, arterial sclerosis or lupus vasculopathy patients were older (arterial sclerosis=37.9±13.0 and lupus vasculopathy=44.4±8.9 versus controls=33.1±8.9 years, P,0.05), and the mean arterial pressurewas higher in all groups compared with controls. Nephritis subtype, activity indices, and proteinuria were similar between groups, estimated GFR was lower in arterial sclerosis (70.5±33.3 versus 84.5±26.6 ml/min per 1.73 m 2, P=0.03), and chronicity index (thrombotic microangiopathy=3.5, lupus vasculopathy=4.5, and arterial sclerosis=2.5) was higher in all renal vascular lesions subgroups versus controls (1.0, P,0.05). In 133 patientswith similar follow-up, the association between renal vascular lesions and vascular eventswas significant (Fisher exact test, P=0.002) and remained so after multivariate analysis (exact conditional scores test, P=0.04), where the difference between arterial sclerosis and uncomplicated vascular immune deposits was most noticeable (odds ratio [95% confidence interval]=8.35[0.98, 83.12], P=0.05). The associations between renal vascular lesions, renal outcomes, and death were not significant, likely because of insufficient power. Conclusions Renal vascular lesions are common in SLE patients with nephritis and may be associated with arterial vascular events.

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