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Lupus nephropathy affects more than half of patients with systemic lupus erythematosus, so pathological diagnosis is key to establishing a prognosis and planning treatment. In addition to glomerulonephritis, different important histopathological lesions have been studied, such as vascular lesions, tubulointerstitial lesions, and podocytopathy. This type of extraglomerular lesions continues to be a challenge in the course of the disease because they have a negative impact on the patient's prognosis. The most common kidney vascular lesions are deposits of immune complexes in extraglomerular arterioles, thrombotic microangiopathy (consisting of antiphospholipid syndrome, hemolytic uremic syndrome, scleroderma, thrombotic thrombocytopenic purpura) activated by the classic complement pathway, kidney vasculitis, and atherosclerosis. The objective of the study is to know the prevalence of vasculopathy, defined by the deposition of immune complexes in the vascular walls in patients with lupus nephritis and the association with outcomes such as a decrease in renal function (glomerular filtration rate (GFR) < 60 ml /min/1.73 m2 and 15 ml/min/1.73 m2, death, decrease in urinary protein/creatinine (UPC) <3 mg/g and <1 mg/g).
Retrospective cohort study. The records of patients with lupus nephritis with renal biopsy from the period from 2012 to 2016 were searched. Results of renal function markers (creatinine, GFR, urinary proteinuria, proteinuria/creatinine ratio) and histological data from the renal biopsy were collected.
Conclusions
The presence of vasculopathy has been related to a worse prognosis in patients with lupus nephritis. In our study, we observed that the deposition of immune complexes in vascular walls is associated with having a lower GFR at the time of diagnosis, compared to those who did not have it; Furthermore, these patients had a higher risk of requiring renal replacement therapy at the time of diagnosis. These results highlight the importance of having a focus beyond just the glomerulus, since the simple fact of having immune complexes deposited on vascular walls, detected by immunofluorescence, can predict a worse prognosis.