Lupus & antiphospholipid syndrome
Beyond glomeruli: interstitial fibrosis and tubular atrophy predict poor renal outcomes in lupus nephritis
Authors' conclusion
Moderate-to-severe IFTA was a strong predictor of renal non-response and ESRD progression. TII defined according to the NIH activity index, which does not include systematic assessment of tubulitis or total cortical inflammatory burden, was not independently associated with outcomes.
Study context
- Population
- Lupus nephritis (LN) patients with renal biopsy episodes
- Participants
- 135 patients195 renal biopsy episodes
- Exposure
- Moderate-to-severe NIH-TII and interstitial fibrosis and tubular atrophy (IFTA) in LN renal biopsies and their association with renal outcomes
- Outcome
- Prevalence, associated factors and prognostic performance of NIH-TII and IFTA for renal outcomes (non-renal response, ESRD progression)
Methodological detailsmultivariable logistic regression, multivariable Cox regression, longitudinal analyses
- Multivariable logistic regression
- Multivariable Cox regression
- Longitudinal analyses
Main finding
As reported in the abstract
- Moderate-to-severe IFTA predicting non-renal response (multivariable logistic regression), OR
- 4.92
- Prior LN episodes predicting non-renal response (multivariable logistic regression), OR
- 8.4
- Moderate-to-severe IFTA predicting ESRD progression (multivariable Cox regression), HR
- 8.93
- Prior LN episodes predicting ESRD progression (multivariable Cox regression), HR
- 8.55
- Thrombotic microangiopathy predicting ESRD progression (multivariable Cox regression), HR
- 12.99
Observational data: associations, not effects.
Further findings
Prevalence of tubulointerstitial lesions among renal biopsies
- Class IV LN (most frequent)
- 49.2%
- Tubulointerstitial involvement
- 74.3%
- Isolated NIH-TII
- 14.4%
- Isolated IFTA
- 15.9%
- Both NIH-TII and IFTA
- 44.1%
- Moderate-to-severe NIH-TII
- 11.3%
- Moderate-to-severe IFTA
- 15.9%
Longitudinal change in IFTA
- Frequent progression of IFTA over time with increasing chronicity index
Original publication
Beyond glomeruli: interstitial fibrosis and tubular atrophy predict poor renal outcomes in lupus nephritis. Arthritis Res Ther. Published 21 March 2026. doi:10.
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