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Lupus nephritis (LN) is first among the autoimmune diseases which cause end-stage chronic kidney disease; its diagnosis could result in the need for kidney function replacement. There is little local information regarding its clinicopathologic presentation and its evolution in our population. The objective of this presentation is to describe a series of patients with lupus nephropathy treated at our institution, their clinical characteristics, histological behavior and treatment.
Observational and prospective study of adult patients with lupus nephropathy who underwent at least one kidney biopsy between March 2019 and July 2023.
Of the 235 kidney biopsies in our registry, 75 (31.9%) included patients with lupus nephritis. Socioeconomic, anthropometric, analytical and histopathological variables were analyzed. All data was reviewed by a nephropathologist without access to patient information and classified according to the 2018 revision of the Classification of Lupus Nephritis according to the International Society of Nephrology/Renal Pathology Society. 74.4% percent of patients had their first biopsy and 18.7% had a second biopsy. Gender distribution was 87% female and 13% male. Average age for the total population was 30 ± 13.24 years (range 16 - 82). Average BMI was 24.9 ± 6.13 (range 16.01 – 42.86). Sixty-four percent of patients presented extrarenal symptoms on admission, with hematological manifestations being the most frequent (80%), followed by articular (21%), mucocutaneous (19%), serous (15%) and pulmonary (6%). High blood pressure was recorded in 73% of patients. It is notable that 55.3% presented with a glomerular filtration rate <60 ml/min and 6.7% of the total population required dialysis at the moment of their kidney biopsy. Hematuria-proteinuria (48%) and nephritic/nephrotic syndrome (24%) were the most common symptoms. The average proteinuria was 2.7 ± 2.1 (range 0.26 – 20). 70.7% of patients had positive ANA titers, 60% had positive Anti-dsDNA titers; 4% had positive c-ANCA/p-ANCA titers. Percutaneous renal biopsy results indicated class IV proliferative nephropathy in 60.3% of patients, followed in frequency by pure class V in 16% of patients, class III/IV + V in 10.6% and class II in 9.3%. All patients received therapeutic intervention. 97.7% received nephroprotective treatment and 89.3% received immunosuppressive treatment at the time of the kidney biopsy (59% steroids, 17% Mycophenolic Acid and 9% Cyclophosphamide).
Results show that 73% of patients presented arterial hypertension as the most frequent comorbidity. As has been documented previously, LN is more common in females and biopsies allowed us to identify class IV as the most frequent class of LN in these patients. Early detection and referral of patients with LN allows for timely approach and treatment, which could limit rapid deterioration of kidney function and progression to end-stage chronic kidney disease.