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Tubulointerstitial damage predicted renal disease in patients with lupus

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WASHINGTON — Tubulointerstitial damage can predict end-stage renal disease progression in patients with lupus and mild to moderate renal impairment, according to data presented at the American College of Rheumatology Annual Meeting.

“It has been shown in prior studies that moderate to severe tubulointerstitial regions are associated with poor renal outcomes,” Bojana Jovanovic, MD, rheumatologist at the Albert Einstein College of Medicine in New York City, said in her presentation. “However, it is still not well-understood whether tubulointerstitial damage is simply a late sequela of lupus.”

Jovanovic and colleagues identified 155 patients hospitalized with lupus nephritis and who received kidney biopsies between 2005 and 2015. Renal impairment was considered mild if the estimated glomerular filtration rate (eGFR) was at least 60 mL per minute/1.73m² or moderate if the eGFR was between 30 mL and 60 mL per minute/1.73m². The researchers recorded deaths, lab data, medications, comorbidities, demographic data and end-stage renal disease (ESRD) onset — defined as the time from index biopsy to incident ESRD. They defined tubulointerstitial damage (TID) in accordance with the 2003 International Society of Nephrology and Renal Pathology Society criteria, which requires the presence of moderate to severe tubular atrophy or interstitial fibrosis on renal biopsy. After adjusting for eGFR and lupus class, the researchers evaluated the association between TID and ESRD progression.

The researchers found TID in 12% of biopsies with mild renal impairment and in 35% of biopsies with moderate impairment. Moderate to severe TID was associated with a high risk of ESRD progression in all patients (hazard ratio = 8.3) and in a subgroup of patients with mild impairment at baseline (hazard ratio = 5.6).

“[Early] detection and treatment of tubulointerstitial inflammation and damage may improve outcomes in lupus nephritis,” Jovanovic said. – by Will Offit

Reference:

Jovanovic B, et al. Abstract #964. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.

Disclosure: The researchers report no relevant financial disclosures.