Kidney Week

Abstract: TH-PO0409

Banff Criteria in Lupus Nephritis: Inflammation in Fibrotic Areas (i-IFTA) Predicts Poor Outcomes

Session Information

• Glomerular Diseases: Autoimmune Diseases
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1401 Glomerular Diseases: Mechanisms, including Podocyte Biology

Authors

• Pluess, Marlene, Medizinische Hochschule Hannover, Hanover, NDS, Germany

Marlene Pluess, MD

• Turner-Stokes, Tabitha, Imperial College London, London, England, United Kingdom

Tabitha Turner-Stokes

• Niebusch, Noah, Ruhr-Universitat Bochum, Bochum, NRW, Germany

Noah Niebusch, MD

• Korsten, Peter, St Josef-Stift Sendenhorst, Sendenhorst, NRW, Germany

Peter Korsten, DrMed

• Schmidt, Bernhard M.W., Medizinische Hochschule Hannover, Hanover, NDS, Germany

Bernhard M.W. Schmidt, MD, MS

• Roufosse, Candice A., Imperial College London, London, England, United Kingdom

Candice A. Roufosse, MD, PhD

• Braesen, Jan H., Medizinische Hochschule Hannover, Hanover, NDS, Germany

Jan H. Braesen, MD, PhD

• Goedecke, Vega, Medizinische Hochschule Hannover, Hanover, NDS, Germany

Vega Goedecke, MD

• Lightstone, Liz, Imperial College London, London, England, United Kingdom

Liz Lightstone, MBBS, PhD

• Hinze, Christian, Medizinische Hochschule Hannover, Hanover, NDS, Germany

Christian Hinze, MD, DrMed

Background

Lupus nephritis (LN) is the most common end organ complication of systemic lupus erythematosus (SLE), and shows a heterogeneous response to treatment. The current histopathological classification system focuses almost exclusively on glomerular inflammation. However, tubulointerstitial inflammation can also be prominent and its impact on renal dysfunction and prognosis remains underexplored.

Methods

In this international multi-centre retrospective cohort study, 70 kidney biopsy samples of patients with acute, new-onset LN class III or IV were re-analysed using light microscopy and conventional histopathological stains. Each sample was scored according to the 2018 Banff Classification of Renal Allograft Pathology. Routine clinical data was collected for the time of biopsy and 12 months later. Treatment was documented and the response was classified according to the 2024 KDIGO guidelines for LN, which defines complete remission as an improvement or stabilization in kidney function (eGFR +/- 10-15% of baseline) and a reduction of proteinuria to <500 mg/g creatinine. The correlation between Banff scores and clinical parameters at biopsy as well as treatment response at 12 months was tested in univariate and multivariable models.

Results

87.1% of patients were female, and median age was 36 years. Median eGFR at biopsy was 77 ml/min/1.73m² and proteinuria 1010 mg/g creatinine. A relevant proportion of samples exhibited interstitial inflammation (Banff i_1-3, 24.3%), tubulitis (Banff t_1-3, 22.9%), or peritubular capillaritis (Banff ptc_1-3, 22.5%). Significant inflammation in areas of interstitial fibrosis and tubular atrophy (Banff i-IFTA) was detected in 55.7% of samples. In a multivariable logistic regression model incorporating age, sex, study centre, baseline eGFR, extent of fibrosis and treatment regime as covariates, i-IFTA showed an independent and statistically significant association with non-complete remission at 12 months (OR = 6.0, 95% CI [1.3, 31.6], p = 0.035).

Conclusion

Expanding the Lupus nephritis classification by incorporating Banff criteria is a novel approach that reveals substantial tubulointerstitial inflammation. This study identifies i-IFTA as a clinically relevant but under-recognised histopathological feature in LN, associated with poorer treatment response at one year. The composition of this inflammatory micro-environment warrants further investigation.