Rheumatology International

, Volume 39, Issue 12, pp 2061–2067 | Cite as

Renal flare in class V lupus nephritis: increased risk in patients with tubulointerstitial lesions

  • Oh Chan Kwon
  • Yong Mee Cho
  • Ji Seon Oh
  • Seokchan Hong
  • Chang-Keun Lee
  • Bin Yoo
  • Yong-Gil KimEmail author
Observational Research


The objective of this study is to investigate the risk factors of renal flare in patients with membranous lupus nephritis (class V lupus nephritis). Biopsy-proven pure membranous lupus nephritis patients diagnosed between January 1997 and September 2017 were studied. We assessed and compared the clinical and pathological parameters between patients who experienced renal flare and those who did not. To identify risk factors of renal flare, multivariable Cox proportional hazard regression analysis was performed. Out of the 53 patients with pure membranous lupus nephritis, 17 patients (32.1%) experienced renal flare during a median follow-up of 121.5 months (range 44.4–196.9). Patients who experienced renal flare had significantly higher proportion of tubulointerstitial inflammation (76.5% vs. 36.1%, p = 0.006) and tubular atrophy/interstitial fibrosis (70.6% vs. 27.8%, p = 0.003) at baseline. In multivariable Cox proportional hazard regression analysis, the presence of tubulointerstitial inflammation [adjusted hazard ratio (HR) 5.532, 95% confidence interval (CI) 1.722–17.776, p = 0.004] and tubular atrophy/interstitial fibrosis (adjusted HR 4.328, 95% CI 1.450–12.916, p = 0.009) at baseline was significantly associated with increased risk of renal flare. The presence of tubulointerstitial inflammation and tubular atrophy/interstitial fibrosis is associated with increased risk of renal flare in patients with membranous lupus nephritis.


Membranous lupus nephritis Tubulointerstitial inflammation Tubular atrophy Interstitial fibrosis Flare 



The authors would like to thank Enago ( for the English language review.

Author contributions

OCK and Y-GK contributed to the conception and design of the study, data collection and analysis, manuscript writing, and final approval of the manuscript. YMC, JSO, SH, C-KL, and BY contributed to data collection and analysis, and critically reviewed the manuscript. All authors read and approved the final version of the manuscript.


This work was supported by grants from the Asan Institute for Life Sciences (2019-463).

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures were performed in accordance with the ethical standards of the Institutional Review Board of Asan Medical Center (IRB No: 2018-0137) and with the 1964 Helsinki declaration.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of Internal MedicineUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
  2. 2.Department of PathologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
  3. 3.Department of Biomedical InformaticsUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
  4. 4.Division of Rheumatology, Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea

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