RENAL VASCULAR-LESIONS AS A MARKER OF POOR PROGNOSIS IN PATIENTS WITH LUPUS NEPHRITIS

The frequency of renal vascular lesions (RVL) and their relevance in the progression of renal damage were evaluated by the Pathology Group of the “Gruppo Italiano per to Studio della Nefrite Lupica” (GISNEL). Of 285 patients with lupus nephritis collected from 20 nephrology centers in Italy and classified according to World Health Organization (WHO) criteria, 79 cases (27.7%) with RVL were identified and classified as follows: (1) lupus vasculopathy (n = 27); (2) hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) malignant hypertension-like lesions (n = 24); (3) vasculitis (n = 8); (4) arterio-arteriolosclerosis (n = 20). At the time of renal biopsy, patients with RVL had mean serum creatinine levels significantly higher than patients without RVL (201.8 ± 195.9 µmol/L [2.2 ± 2.2 mg/dL] v 108.1 ± 108.0 µol/L [1.2 ± 1.2 mg/dL]; P < 0.01). Hypertension was more frequent in patients with RVL than in those without (68.4% v 30.5%; P < 0.01). The probability of kidney survival assessed according to the Kaplan-Meier method at 5 and 10 years was, respectively, 74.3% ± 5.9% and 58.0% ± 8.9% in patients with RVL, compared with 89.6% ± 2.7% and 85.9% ± 3.7% in patients without RVL. However, the two groups did not differ significantly as regards overall survival, the probability of survival at 5 and 10 years being 86.5% ± 4.5% and 78.8% ± 6.6% in patients with RVL and 92.2% ± 2.2% and 83.3% ± 4.4% in patients without RVL. This study indicates that RVL are common in lupus nephritis and that they can serve as a valuable marker to identify patients at higher risk of progression to endstage renal failure. © 1991, National Kidney Foundation, Inc.. All rights reserved.