January 29, 2020
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Renal arteriosclerosis accelerated, premature in lupus nephritis

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Shivani Garg

Renal arteriosclerosis is both accelerated and premature among patients with lupus nephritis by 2 decades, compared with healthy peers, according to data published in Arthritis Care & Research.

“Lupus patients with nephritis have a ninefold higher risk of cardiovascular disease and a twofold higher risk of CVD or carotid plaques compared to lupus patients without nephritis,” Shivani Garg, MD, MS, of the University of Wisconsin, Madison, told Healio Rheumatology. “So, there is an urgent need for early predictors of CVD to implement timely CVD prevention strategies.”

To analyze the burden of renal arteriosclerosis among patients with lupus nephritis, as well as to determine whether it is under-reported in biopsies, Garg and colleagues studied data from all consecutive patients with lupus nephritis who underwent kidney biopsy between 1994 and 2017 at the University of Wisconsin Hospital and Clinics. Including 189 incident patients in their analysis, the researchers interpreted the biopsy reports to classify the Banff categories of absent, mild, moderate or severe renal arteriosclerosis.

The researchers then compared the prevalence of renal arteriosclerosis with the published prevalence among age-matched healthy peers. In addition, they analyzed the predictors of arteriosclerosis, and compared biopsies for Banff renal arteriosclerosis grading with pathway reports.

Renal arteriosclerosis is both accelerated and premature among patients with lupus nephritis by 2 decades, compared with healthy peers, according to data.

According to the researchers, the prevalence of renal arteriosclerosis was 2 decades earlier in patients with lupus nephritis, compared with healthy peers, impacting 40% of those aged 31 to 39 years among those with the disease, compared with 44% in those aged 50 to 59 years among healthy peers. In addition, the multivariable analysis revealed 3fold higher odds for renal arteriosclerosis among patients with lupus nephritis aged older than 30 years.

On biopsies, lupus nephritis chronicity predicted 4fold higher odds for renal arteriosclerosis. Lastly, the biopsy overreads found that 50% of standard lupus nephritis biopsy reports omitted reporting the presence or absence of renal arteriosclerosis.

“Renal arteriosclerosis in lupus nephritis patients is significantly early and accelerated compared to healthy peers, but is often overlooked in renal biopsy reports even when it present,” Garg said. “Our study underscores a need for universal use of systematic Banff renal arteriosclerosis grading criteria in all lupus nephritis biopsies, similar to transplant pathology reporting standards. Future efforts will involve examine correlation between renal arteriosclerosis and CVD occurrence in diverse cohorts.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.