Renal flare in class V lupus nephritis: increased risk in patients with tubulointerstitial lesions
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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.
KeywordsMembranous lupus nephritis Tubulointerstitial inflammation Tubular atrophy Interstitial fibrosis Flare
The authors would like to thank Enago (http://www.enago.co.kr) for the English language review.
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.
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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