Associação entre presença de lesões vasculares em biópsias renais de pacientes com Lúpus Eritematoso Sistêmico e progressão para Doença Renal Crônica Terminal

Abstract

A common criticism of lupus nephritis classifications is the relative scarcity of information concerning tubular, interstitial, and vascular changes compared to the detail given to glomerular changes, even though their potential for independent progression is known. This study aims to evaluate the association between presence of vascular lesions in renal biopsies of patients with systemic lupus erythematosus and renal survival of these patients. This is a retrospective cohort that analyzed histological material, clinical and biochemical data of patients with biopsy-proven lupus nephritis collected at the Immunofluorescence and Electron Microscopy Laboratory of the Presidente Dutra University Hospital (LIME-HUUFMA). Sixty-five renal biopsies from Maranhão, Rio Grande do Norte and Alagoas were evaluated from May 2014 to June 2018 at LIME-HUUFMA. After a median follow-up of 15.3 months (interquartile range (IQ) 7.7 - 22.0), patients who had no vascular changes at renal biopsy had better renal survival: 97.2%, 82.3% , 75.0% and 33.3% (p = 0.006) respectively, for the no vascular lesions (NVL), arterial sclerosis (AS), thrombotic microangiopathy and noninflammatory necrotizing vasculopathy (NNV) group. There were no cases of True Renal Vasculitis (TRV) in the sample studied. In the univariate Cox regression analysis, the factors associated with progression to ESRD were serum creatinine at presentation, need for RRT during follow-up, and presence of TMA and NNV. However, in the multivariate analysis, only the presence of TMA and basal creatinine were independent predictors of progression to ESRD. Thus, renal vascular lesions, especially TMA, correlate with worse renal prognosis in patients with lupus nephritis, but it is not clear whether this occurs independently of lesions present in activity and chronicity scores.