Assessment of microvascular involvement in lupus nephritis patients by retinal OCT-angiography and kidney biopsies

Abstract

ObjectiveOcular and renal microvascular damage in lupus nephritis (LN) share similar physiopathological pathways that have investigated using traditional fundus examination and high-resolution colour electroretinography. Optical coherence tomography angiography (OCTA) is a recent, non-invasive technique for imaging the microvasculature of retina and choroid. Aim of the study was to investigate through OCTA analysis the relationship between retinal microvasculature alterations and renal function and histologic features. Methods Systemic lupus erythematosus (SLE) patients with LN, SLE without renal involvement and healthy controls were recruited and accomplished an ophthalmological evaluation, including OCTA. SLE-LN patients underwent a rheumatological evaluation, including disease-related clinical and laboratory features collection and kidney biopsy examination. Results This cross-sectional study enrolled forty-six eyes of 23 LN patients, thirty-two eyes of 16 SLE patients and forty-two eyes of 21 controls. Thirteen SLE-LN patients (56.5%) displayed lupus retinopathy, 10 at moderate (77%) and 3 at severe stage (23%) by fundus oculi examination. Analysis of OCTA data showed with high/moderate accuracy a reduction of retinal capillary vessel density in both SLE and SLE-LN patients compared to controls in superficial and deep plexi.A reduction in fovea thickness and an increase in foveal avascular zone were also detected. OCTA data of LN patients correlated with LN duration, disease activity, kidney function and the presence of LN-vascular lesions at kidney biopsy. ConclusionOur results suggest the role of OCTA in early detection of systemic vascular involvement in SLE-LN patients and related kidney functional-histological impairment.

Quantitative assessment of retinal vasculature changes in systemic lupus erythematosus using wide-field OCTA and the correlation with disease activity

“…Meanwhile, due to the similarity in anatomy and physiology between the brain and eye, when the central nervous system is involved, retinal tissue may also be about to enter the pathological stage, with FAZ morphology becoming more irregular and VD showing a downward trend. The negative results of the renal system in this study were opposite to Conigliaro et al.’s study ( 36 ). Therefore, future studies with larger sample sizes are needed to validate the associations that were found in this study.…”

Microvasculature alterations of peripapillary retina and macula in systemic lupus erythematosus patients without ocular involvement by optical coherence tomography angiography

“…More and more researchers are using OCTA to study the fundus microvascular changes in SLE patients. [8][9][10][11][12][13][14][22][23][24][25][26][27][28][29][30] However, many researchers have found inconsistent results (Table 5). 8,11,13,26,27 In this study, we first evaluated the alterations of pVD in a circular area of F2.5 mm, F3.5 mm, and F5.0 mm, respectively.…”

Relationship between retinal microvascular impairment and subclinical atherosclerosis in SLE

“…It has been investigated in the past for its ability to detect preclinical vascular damage in systemic diseases such as diabetes, arterial hypertension and chronic kidney disease. 8 A relationship between retinal microvascular alterations and CV risk profile was also underlined in patients with coronary artery disease, but further studies is this field are needed. 9 Recently, subclinical retinal microvascular impairment evaluated through OCTA has been detected in patients with SLE compared with HCs.…”

“…10 Moreover, a correlation between retinal microvascular alterations, kidney function parameters and vascular lesions detected at kidney biopsy was assessed in a lupus nephritis cohort. 8 A relationship between IMT and reduced OCTA retinal vascular density has been identified in systemic diseases, such as hypertension and diabetes. 11 12 Therefore, we hypothesised that retinal microvascularisation could reflect systemic vascular damage in SLE.…”