Abstract: SA-PO246

Impact of Extraglomerular Involvement on Clinical Presentation and Outcomes in Patients with Lupus Nephritis

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Gupta, Krishan Lal L., Post Graduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
  • Prasad, Hari Anakutti, Post Graduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
  • Rathi, Manish, Post Graduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
  • Sharma, Aman, Post Graduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
  • Nada, Ritambhra, Post Graduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
Background

In patients with lupus nephritis, treatment and prognosis is characterized by its class which is based on glomerular pathology. Extra glomerular involvement, seen frequently was not considered in classification of lupus nephritis. Aim of this study was to analyze the incidence of tubulointerstitial and vascular involvement in lupus nephritis and their correlation with clinical presentation and outcomes.

Methods

This was a prospective retrospective cohort study including patients with biopsy proven lupus nephritis. A total of 241 patients were included in the study period between January2010 - June2016.

Results

The mean age of study population was 29 years. Among 241 patients in the study group, male: female ratio was 1:7. Although the clinical parameters at presentation were similar between the two groups, male patients had poor outcomes when compared with females (response rates 58.6%vs79.7%, P-0.04; resistant disease 34.5%vs15.7%, P-0.01). Interstitial involvement including interstitial inflammation, interstitial fibrosis and tubular atrophy was seen in 60.1% and vascular involvement was seen in 32.3% of biopsies (Table1). Patients with interstitial involvement had worse clinical parameters at presentation and poor outcomes at the end of 6 months of therapy (response rates 65.5%vs82.7%, P<0.01; resistant disease - 21.3%vs10.7%, P-0.03). Similarly in those with vascular involvement also had worse clinical parameters at presentation and poor outcomes (complete remission 38.2%vs61.9%, P<0.01; resistant disease - 26.3%vs14.3%, P=0.02). This trend of poor outcomes was especially seen in those with vascular TMA (response rates - 60%vs79.1%, P-0.04)(Table1).

Conclusion

The involvement of extraglomerular compartment in lupus nephritis patients is common and they play an important role in determining the outcomes along with glomerular lesions.

Distribution of Extra glomerular lesions on renal biopsy
TUBULOINTERSTITIAL INVOLVEMENT145 (60.1%)VASCULAR INVOLVEMENT78 (32.3%)
Interstitial inflammation93
(38.5%)
Asymptomatic vascular immune deposits13
(5.3%)
Interstitial fibrosis/
Tubular atrophy
115
(47.7%)
Vasculopathy5
(2%)
  Vasculitis 2
(0.8%)
  Vascular TMA27 (11.2%)
  Arteriosclerosis55 (22.8%)