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Abstract: FR-PO1113

Clinical Outcomes and Response to Anti-Thrombotic Treatment Among Patients with Concomitant Lupus Nephritis and Thrombotic Microangiopathy: A Multicentre Cohort Study

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Sciascia, Savino, Center of Research of Immunopathology and Rare Diseases (CMID), Division of Clinical Immunology, Giovanni Bosco Hospital and University of Turin, Ita, Turin, Italy, Italy
  • Fenoglio, Roberta, Hospital Hub San Giovanni, Turin, Italy
  • Roccatello, Dario, Ospedale San GIovanni Bosco, Torino, Italy
Background

The renal vascular involvement is an important prognostic marker of lupus nephritis (LN). The thrombotic microangiopathy (TMA) presents with severe clinical manifestations and have a high mortality. However, the management of patients (pts) with TMA and LN needs further investigation. AIM: We sought to assess renal outcomes to anti-thrombotic treatments in addition to conventional immunosuppression (IS) in pts with biopsy proven LN and TMA

Methods

97 pts with biopsy-proven LN and TMA were retrospectively analysed. A complete response (CR) was defined as proteinuria <0.5 g/24h and normal or near-normal (within 10% of normal GFR if previously abnormal) GFR. Partial Response (PR) was defined as a ≥50% reduction in proteinuria to subnephrotic levels and normal or near-normal GFR. Renal outcomes were assessed at 1 year post biopsy.

Results

The mean age of the pts was 38.9±15.2 years. The clinical presentations were nephrotic syndrome, nephritic syndrome, and asymptomatic urinary abnormalities. 9 pts were classified Class III (including 2 as ClassIII + V), 82 as Class IV (10 as Class IV-segmental(IV-S) and 72 as Class IV-global (IV-G), including 4 as Class IV-G +V) and 6 as Class V. 42 (43%) pts presented with acute and 55 (57%) with features of chronic TMA. All pts had received treatment with standard IS and steroids. At 12 months, CR was observed in 37 pts (38.1%), PR in 22 (22.6%) and no response in 38 (39.1%). 61 patients (62.9%) were antiphospholipid positive (aPL) and 37 (38.1%) received anticoagulation with vitamin-K antagonist (VKA) and/or heparins. Presence of aPLs (OR, 2.4; p=0.03), anti-DNA positivity (OR, 12.8; p=0.002), and chronic features of TMA (OR, 3.0; p=0.04) were all found to be associated with no response. In aPL positive pts, variables that were significantly associated with CR+PR were features of acute TMA rather than chronic (OR, 8.62; 95% CI 1.4–97.1; p=0.03) and the use of VKA/heparins (OR, 2.1; 95% CI 1.02–16.2; P=0.046).

Conclusion

In pts with concomitant LN and TMA, the presence of aPL and chronic features of TMA were associated with poorer renal outcomes. In pts with aPL, the use of anticoagulation appeared protective and warrants further investigation as a therapeutic tool, especially in the setting of acute TMA.