Renal Thrombotic Microangiopathy in Proliferative Lupus Nephritis: Risk Factors and Clinical Outcomes

Barrera‐Vargas, Ana; Rosado-Canto, Rodrigo; Merayo-Chalico, Javier; Arreola-Guerra, José M.; Mejía-Vilet, Juan M.; Correa‐Rotter, Ricardo; Gómez‐Martín, Diana; Alcocer‐Varela, Jorge

doi:10.1097/rhu.0000000000000425

Cited by 23 publications

(17 citation statements)

References 44 publications

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“…Concurrent TMA has been observed in 8–15% of systemic lupus erythematosus (SLE) biopsies and was reported to have no influence on outcome [ 352 , 353 ] in some cohorts, but was associated with worse renal outcome in another [ 354 ]. In a mouse model of SLE, C5 inhibition increased survival [ 206 ]; in humans hypocomplementaemia correlates with disease activity [ 207 ], and CFHR3/1 deletion is associated with susceptibility to SLE [ 208 ].…”

Section: Evidence For the Role Of Complement In The Tmasmentioning

confidence: 99%

Complement C5-inhibiting therapy for the thrombotic microangiopathies: accumulating evidence, but not a panacea

Brocklebank

Kavanagh

2017

Clinical Kidney Journal

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Thrombotic microangiopathy (TMA), characterized by organ injury occurring consequent to severe endothelial damage, can manifest in a diverse range of diseases. In complement-mediated atypical haemolytic uraemic syndrome (aHUS) a primary defect in complement, such as a mutation or autoantibody leading to over activation of the alternative pathway, predisposes to the development of disease, usually following exposure to an environmental trigger. The elucidation of the pathogenesis of aHUS resulted in the successful introduction of the complement inhibitor eculizumab into clinical practice. In other TMAs, although complement activation may be seen, its role in the pathogenesis remains to be confirmed by an interventional trial. Although many case reports in TMAs other than complement-mediated aHUS hint at efficacy, publication bias, concurrent therapies and in some cases the self-limiting nature of disease make broader interpretation difficult. In this article, we will review the evidence for the role of complement inhibition in complement-mediated aHUS and other TMAs.

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Section: Evidence For the Role Of Complement In The Tmasmentioning

confidence: 99%

Complement C5-inhibiting therapy for the thrombotic microangiopathies: accumulating evidence, but not a panacea

Brocklebank

Kavanagh

2017

Clinical Kidney Journal

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“…The authors did not find an association with positive aPL. However, patients with TMA had worse renal prognosis ( 62 ).…”

Section: Introductionmentioning

confidence: 99%

Renal Involvement in Antiphospholipid Syndrome

2018

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Antiphospholipid syndrome is a complex autoimmune disease, characterized by the presence of vascular thrombosis, obstetric, hematologic, cutaneous, and cardiac manifestations. Renal disease in patients with antiphospholipid syndrome was not recognized in the first descriptions of the disease, but later on, the renal manifestations of the syndrome have been investigated widely. Renal manifestations of antiphospholipid syndrome conform a wide spectrum of diverse renal syndromes. Hypertension is one of the most frequent, but less commonly recognized renal alteration. It can be difficult to control as its origin is renovascular. Renal vascular thrombosis can be arterial or venous. Other alterations are renal infarction and vascular thrombosis in arterial territories. Venous thrombosis can be present in primary and secondary antiphospholipid syndrome; it presents with worsening of previous proteinuria or de novo nephrotic syndrome, hypertension and renal failure. Antiphospholipid syndrome nephropathy is a vascular disease that affects glomerular tuft, interstitial vessels, and peritubular vessels; histopathology characterizes the renal lesions as acute or chronic, the classic finding is thrombotic microangiopathy, that leads to fibrosis, tubule thyroidization, focal cortical atrophy, and glomerular sclerosis. Antiphospholipid syndrome nephropathy can also complicate patients with systemic lupus erythematosus, and there is vast information supporting the worse renal prognosis in this group of patients with the classic histopathologic lesions. Treatment consists of anticoagulation, as for other thrombotic manifestations of antiphospholipid syndrome. There is some evidence of glomerulonephritis as an isolated lesion in patients with antiphospholipid syndrome. The most frequently reported glomerulonephritis is membranous; with some reports suggesting that immunosuppressive treatment may be effective. Patients with end stage renal disease commonly are positive for antiphospholipid antibodies, but it is not clear what is the role of aPL in this setting. Patients with vascular access may have complications in the presence of antibodies so that anticoagulation is recommended. Patients ongoing renal transplant with persistent antiphospholipid antibody positivity may have early and late graft failure.

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“…This study showed lymphopenia and anti-Ro positivity as independent risk factors for developing renal TMA. It also showed no significant difference in outcomes for patients with similar eGFR with or without TMA, and no significant effect on renal survival in TMA patients [18]. A study out of Northern Taiwan including 2461 SLE patients highlighted infection as a potential major trigger for TMA occurrence [9].…”

Section: Discussionmentioning

confidence: 97%

“…Previously, Barrera-Vargas et al [18] attempted to identify possible risk factors contributing to TMA in SLE patients, and further define TMA's impact on clinical outcomes. This study showed lymphopenia and anti-Ro positivity as independent risk factors for developing renal TMA.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States

et al. 2020

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Background: This study aimed to evaluate thrombotic microangiopathy’s (TMA) incidence, risk factors, and impact on outcomes and resource use in hospitalized patients with systemic lupus erythematosus (SLE). Methods: We used the National Inpatient Sample to construct a cohort of hospitalized patients with SLE from 2003–2014. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between SLE patients with and without TMA. Results: Of 35,745 hospital admissions for SLE, TMA concurrently presented or developed in 188 (0.5%) admissions. Multivariable analysis showed that age ≥ 40 years and Hispanics were significantly associated with decreased risk of TMA, whereas Asian/Pacific Islanders and history of chronic kidney disease were significantly associated with increased risk of TMA. TMA patients required more kidney biopsy, plasmapheresis, mechanical ventilation, and renal replacement therapy. TMA was significantly associated with increased risk of in-hospital mortality and acute conditions including hemoptysis, glomerulonephritis, encephalitis/myelitis/encephalopathy, hemolytic anemia, pneumonia, urinary tract infection, sepsis, ischemic stroke, seizure, and acute kidney injury. The length of hospital stays and hospitalization cost was also significantly higher in SLE with TMA patients. Conclusion: TMA infrequently occurred in less than 1% of patients admitted for SLE, but it was significantly associated with higher morbidity, mortality, and resource use.

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Renal Thrombotic Microangiopathy in Proliferative Lupus Nephritis: Risk Factors and Clinical Outcomes

Cited by 23 publications

References 44 publications

Complement C5-inhibiting therapy for the thrombotic microangiopathies: accumulating evidence, but not a panacea

Complement C5-inhibiting therapy for the thrombotic microangiopathies: accumulating evidence, but not a panacea

Renal Involvement in Antiphospholipid Syndrome

Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States

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