Kidney Week

Abstract: TH-PO0752

Clinical and Pathological Characteristics of Patients with Lupus Nephritis and Concomitant Thrombotic Microangiopathy

Session Information

• Glomerular Histopathology: Evolving Insights
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Bobart, Shane A., Houston Methodist, Houston, Texas, United States

Shane A. Bobart, MD, FASN

• Javed, Mahnoor, Houston Methodist, Houston, Texas, United States

Mahnoor Javed, DO

• Aveytia Camacho, Alma A, Houston Methodist, Houston, Texas, United States

Alma A Aveytia Camacho, MD

• Riaz, Maryam, Houston Methodist, Houston, Texas, United States

Maryam Riaz, DO

• Lowe, Jessica Elise, Houston Methodist, Houston, Texas, United States

Jessica Elise Lowe, MD

• Aslam, Nabeel, Mayo Clinic in Florida, Jacksonville, Florida, United States

Nabeel Aslam, MD, FASN

• Hickson, LaTonya J., Mayo Clinic in Florida, Jacksonville, Florida, United States

LaTonya J. Hickson, MD, FASN

• Adrogue, Horacio E., Houston Methodist, Houston, Texas, United States

Horacio E. Adrogue, MD, DrMed, FASN

• Edwards, Angelina, Houston Methodist, Houston, Texas, United States

Angelina Edwards, MD, FASN

• Guevara, Myriam, Houston Methodist, Houston, Texas, United States

Myriam Guevara, MD

Background

Thrombotic microangiopathy (TMA) can be seen in up to 24% of patients with lupus nephritis and may be renally limited or have systemic manifestations. It may also occur in the setting of autoimmunity, with an overall poor prognosis. This study examines a cohort of patients with biopsy-proven lupus nephritis with concomitant TMA lesions on kidney biopsy, highlighting their clinical associations and outcomes.

Methods

We reviewed the medical records of 255 patients with biopsy-proven lupus nephritis from June 2015 to December 2023 at Houston Methodist Hospital, identifying 7 patients with concomitant TMA on renal biopsy. We manually extracted pathological and clinical characteristics of these patients from their electronic medical record.

Results

The mean age at presentation was 46 years. Of 7 patients, 6 were female, 4 African American, and 3 had a history of tobacco use. LN classes included Class III (n=3), Class IV (n=2), and Class V (n=2). Two patients had positive anti-phospholipid antibodies, and most had hypocomplementemia (mean C3: 73±41 U/mL, C4: 17±15 U/mL). Mean serum creatinine, eGFR, and proteinuria at presentation were 2.9±2.6 mg/dL, 39±24 mL/min/1.73m², and 5.5±5.6 g/day, respectively. Three patients (43%) progressed to end stage kidney failure (ESKF) requiring dialysis. The remaining four achieved partial remission with a mean creatinine of 1.2±0.4 mg/dL, eGFR of 68±15.7 mL/min/1.73m², and UPCR of 0.9±0.6 g at 6 months. Clinical and treatment details are summarized in Table 1.

Conclusion

In patients with lupus nephritis and TMA on biopsy, African American race, obesity, and tobacco use were common. Only 29% had antiphospholipid antibodies, suggesting TMA can occur independently of APL-Ab. Notably, 43% developed ESKF and had higher creatinine and proteinuria at presentation. hese findings highlight the importance of close monitoring and the need for larger studies to better define the clinical course of TMA in LN, ultimately guiding future treatment strategies and improving prognostic accuracy.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025pqx5nr67