Lupus & antiphospholipid syndrome
Predicting kidney outcomes among Latin American patients with lupus nephritis: The prognostic value of interstitial fibrosis and tubular atrophy and tubulointerstitial inflammation
Authors' conclusion
Patients with moderate-to-severe IFTA had worse kidney survival than those with none or mild IFTA. Worse kidney survival was also found among those with class IV LN and fibrous crescents versus those without IV LN and fibrous crescents, respectively.
Study context
- Population
- Latin American patients with biopsy-proven lupus nephritis (LN)
- Participants
- 285 patients
- Exposure
- Moderate-to-severe interstitial fibrosis and tubular atrophy (IFTA) vs none or mild IFTA
- Outcome
- Kidney survival: time from initial biopsy to ESKD, dialysis or transplant
Methodological detailsKaplan-Meier with log-rank test, competing-risk analysis, multivariable Cox regression
- Kaplan-Meier with log-rank test
- Competing-risk analysis
- Multivariable Cox regression
Main finding
As reported in the abstract
Kidney survival by IFTA
- Moderate-to-severe IFTA had worse kidney survival than none or mild IFTA
- Moderate-to-severe IFTA vs None or mild IFTA: P = 0.018
- Moderate-to-severe IFTA vs None or mild IFTA: P = 0.017
Observational data: associations, not effects.
Further findings
Predictors of end-stage kidney disease (ESKD), multivariable Cox regression
| HR (95% CI) | ||
|---|---|---|
| Older ageAdjusted for sex, ethnicity, TII, and IFTA | 1.04 (1.01–1.07) | |
| Class IV ± V LNAdjusted for sex, ethnicity, TII, and IFTA | 5.06 (1.82–14.09) | |
| 0.050.21520Hazard ratio (log scale) |
Predictors of ESKD, competing-risk analyses
| SHR (95% CI) | ||
|---|---|---|
| Class IV ± V LN | 3.32 (1.25–8.83) | |
| No response to immunosuppressive therapy | 4.55 (1.54–13.41) | |
| 0.050.21520Subdistribution hazard ratio (log scale) |
| Outcome | SHR (95% CI) | |
|---|---|---|
| Predictors of ESKD, competing-risk analyseseGFR >90 mL/min/1.73 m² · for each ml/min/1.73 m²; lower risk | 0.98 (0.97–0.99) | |
| 0.512Subdistribution hazard ratio (log scale) |
| Outcome | P value |
|---|---|
| Kidney survival, class IV ± V LN vs non-class IV LNClass IV ± V LN vs Non-class IV LN · Kaplan-Meier; worse kidney survival | P = 0.050 |
| Kidney survival, class IV ± V LN vs non-class IV LNClass IV ± V LN vs Non-class IV LN · competing-risk analysis; not significant | P = 0.154 |
| Kidney survival, fibrous crescents vs noneFibrous crescents vs No fibrous crescents · Kaplan-Meier; worse kidney survival | P = 0.010 |
| Kidney survival, fibrous crescents vs noneFibrous crescents vs No fibrous crescents · competing-risk analysis | P = 0.011 |
Progression to ESKD (whole cohort) · median 4.2 (2.0-55.2) months after biopsy
- Progressed to ESKD
- 57 (20%)
Prevalence of tubulointerstitial inflammation (TII) and IFTA in biopsies
- TII present
- 206 (72.3%)
- IFTA present
- 99 (34.7%)
Original publication
Predicting kidney outcomes among Latin American patients with lupus nephritis: The prognostic value of interstitial fibrosis and tubular atrophy and tubulointerstitial inflammation. Lupus. Published 17 January 2023. doi:10.
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