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
From the Departments of *Immunology and Rheumatology, †Nephrology and Mineral Metabolism; and ‡Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
J Clin Rheumatol. 2016 Aug;22(5):235-40. doi: 10.1097/RHU.0000000000000425.
Renal thrombotic microangiopathy (TMA) may be associated with lupus nephritis. Its relationship to other disease factors and its specific effect on prognosis are not precisely known. Evidence regarding these aspects is controversial, and information focusing on kidney-limited TMA in systemic lupus erythematosus (SLE) patients is scarce.
The aims of this study were to identify risk factors for renal TMA in patients with lupus nephritis and to determine its impact on clinical outcomes.
A case-control study was performed. We studied 245 renal biopsies from SLE patients. We included patients with renal TMA, as well as control subjects adjusted for glomerulonephritis class, estimated glomerular filtration rate, activity and chronicity indices, and follow-up time. Serological and clinical features were measured at the time of the biopsy and during follow-up.
Twenty-three patients with renal TMA and 21 control subjects were included. There were no differences in Systemic Lupus Erythematosus Disease Activity Index score, end-stage renal disease, or mortality between groups during follow-up. After multivariate analysis, lymphopenia (odds ratio, 10.69; 95% CI, 1.35-84.74) and anti-Ro antibody positivity (odds ratio, 8.96; 95% CI, 1.49-53.57) remained significantly associated with renal TMA.
Lymphopenia and anti-Ro positivity are independent risk factors for renal TMA in SLE patients. This increased risk could be a consequence of the potential role of these factors in endothelial dysfunction and damage. Outcomes were similar for patients with the same estimated glomerular filtration rate and biopsy characteristics, regardless of the presence of TMA.
肾血栓性微血管病（TMA）可能与狼疮性肾炎相关。其与其他疾病因素的关系及其对预后的具体影响尚不完全清楚。关于这些方面的证据存在争议，且针对系统性红斑狼疮（SLE）患者中肾脏局限性TMA的信息较少。
本研究旨在确定狼疮性肾炎患者发生肾TMA的危险因素，并确定其对临床结局的影响。
进行了一项病例对照研究。我们研究了245例SLE患者的肾活检样本。纳入了肾TMA患者以及根据肾小球肾炎分级、估计肾小球滤过率、活动度和慢性指数以及随访时间进行调整的对照受试者。在活检时和随访期间测量血清学和临床特征。
纳入了23例肾TMA患者和21例对照受试者。随访期间两组之间的系统性红斑狼疮疾病活动指数评分、终末期肾病或死亡率无差异。多因素分析后，淋巴细胞减少（比值比，10.69；95%置信区间，1.35 - 84.74）和抗Ro抗体阳性（比值比，8.96；95%置信区间，1.49 - 53.57）仍与肾TMA显著相关。
淋巴细胞减少和抗Ro阳性是SLE患者发生肾TMA的独立危险因素。这种风险增加可能是这些因素在内皮功能障碍和损伤中潜在作用的结果。对于具有相同估计肾小球滤过率和活检特征的患者，无论是否存在TMA，结局相似。
