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Abstract: PO1434

Tertiary Lymphoid Tissue Development Is Associated with Impaired Renal Function in Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Sato, Yuki, Medical Innovation Center TMKP, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • Kondo, Makiko, Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • Fukuma, Shingo, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • Toriu, Naoya, Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • Ubara, Yoshifumi, Department of Nephrology, Toranomon Hospital, Tokyo, Japan
  • Yanagita, Motoko, Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Background

Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus (SLE) and the pathophysiology is heterogenous. Recently, the careful assessment of not only glomerular but tubulointerstitial lesions has been proposed for more precise evaluation of the disease activity, which leads to better management. Tertiary lymphoid tissues (TLTs) are inducible ectopic lymphoid tissues formed in the kidney interstitium under chronic inflammation. Several studies have reported TLTs in LN, though the frequencies, clinical characteristics and relevance in LN have been undefined.

Methods

We examined the presence of TLTs in 205 kidney biopsy samples of patients with LN and investigated the clinical characteristics of patients with renal TLTs. TLTs were defined as organized T and B cell aggregates with sign of proliferation. Histological activity and damage at biopsy were calculated as the National Institute of Health (NIH) activity and chronicity indices (CI).

Results

43 patients (21%) exhibited TLTs in the kidneys. There were no significant differences in ISN/RPS classification between LN patients with TLTs and those without TLTs. TLT development was not associated with disease activity indicators, such as SLEDAI, dsDNA titer, proteinuria, or complement factors, but it was associated with reduced eGFR (60.2 versus 83.8 ml/min/1.73m2, P = 0.001) and higher histological kidney injury scores (P = 0.0038). A higher prevalence of TLTs was observed with age over 40 years old and non-treatment history of immunosuppressive drugs. Additionally, TLT development was associated with incidence of hypertension.

Conclusion

Association between TLT development and reduced eGFR and higher histological injury suggest the potential of TLTs as an additional histological marker for evaluation of LN disease activity. Dissociation between TLT development and SLE disease activity indexes such as SLEDAI and dsDNA antibody titers also suggest that TLTs development are, at least partly, independent of the severity of glomerulonephritis.

Funding

  • Government Support – Non-U.S.