Abstract: SA-PO243

Acute Tubular Necrosis in Lupus Nephritis

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Wadhwani, Shikha, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Leisring, Joshua, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Satoskar, Anjali A., Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Parikh, Samir V., Ohio State University Wexner Medical Center, Columbus, Ohio, United States
  • Rovin, Brad H., Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Background

Glomerular pathology drives management of lupus nephritis (LN) although acute tubular necrosis (ATN) is frequently seen on biopsy. The prevalence and significance of ATN in LN is unknown. To address these questions, we queried our native kidney biopsy data base.

Methods

309 patients who underwent kidney biopsy from 2004 to 2011 were found to have LN. Pathology reports were reviewed for ISN/RPS class, glomerular histology, and tubulointerstitial damage, including presence of ATN. The relationship of ATN to patient demographics, pathology findings, and long-term outcomes were examined using Fischer’s exact or Mann-Whitney tests, as appropriate.

Results

ATN was found in 78 (25%) LN patients. Patients with ATN had significantly higher serum Cr (2.18 ± 29 vs 1.55 ± 1.37 mg/dL; p<0.001) and proteinuria (4.66 ± 4.33 vs 3.22 ± 3.05 g/g; p=0.032) at time of biopsy than those without ATN. The presence of ATN was not affected by race or gender. Patients with active crescents (p = 0.006), glomerular capillary necrosis (p=0.035), or interstitial inflammation (p<0.001) were significantly more likely to have ATN than patients without these lesions. The degree of interstitial fibrosis and tubular atrophy was not increased in patients with ATN. Of the patients with at least 3 years of follow-up (mean 7.3 ± 2.2 years in ATN group, 8.4 ± 2.3 years in no ATN group), serum Cr at follow-up was not significantly different in those with ATN (n=20) and those without (n=62).

Conclusion

ATN commonly accompanies severe glomerular injury in LN, and is associated with impaired kidney function and high levels of proteinuria. However patients with ATN do not seem to have more long-term renal damage than patients without ATN.

Funding

  • Clinical Revenue Support