Focal necrotizing glomerular lesions (FNGL) in patients with lupus nephritis (LN) are commonly associated with crescents formation and may have worse renal outcomes. Clinical factors predictive of FNGL remain unclear. This study was aimed to identify such factors.
The cross-sectional study included 133 cases of biopsy-proven LN. Clinical and histological data were analyzed at the time of kidney biopsy (Bx). FNGL defined as the presence of cellular/fibrocellular crescents.
FNGL were found in 27% of LN cases and had more pronounced active glomerular and tubulointerstitial histological lesions and clinical manifestations (table 1). Acute kidney injury (AKI) at the time of Bx (HR 6.10, 95%CI 1.57-23.75) and the abnormal anti-dsDNA levels in combination with the decrease in serum C3 and/or C4 complement (НR 9.99, 95%CI 2.10-47.25) were independently associated with FNGL.
| Parameters | No FNGL, n=97 | FNGL, n=36 | p-value |
|---|---|---|---|
| eGFR, mL/min/1.73 m2 | 65 (43;102) | 47 (33;91) | 0,11 |
| Proteinuria, g/24h | 3,05 (1,14;6,45) | 6,30 (3,45;9,50) | 0,003 |
| Urine RBC, n | 9 (2;23) | 48 (10;85) | <0,001 |
| AKI, % | 8,3 | 33,0 | <0,001 |
| Anti-dsDNA, IU/mL | 66 (13;257) | 250 (89;378) | 0,002 |
| Serum C3, g/L | 0,695±0,292 | 0,491±0,291 | 0,006 |
| Serum C4, g/L | 0,150±0,086 | 0,097±0,077 | 0,013 |
| Low C3 or C4, % | 68,0 | 90,0 | 0,018 |
| SELENA-SLEDAI | 12 (8;18) | 19 (14;21) | <0,001 |
anti-dsDNA, anti-double-stranded DNA antibodies; eGFR, estimated glomerular filtration rate; RBC, red blood cell; data presented as mean±SD or median (interquartile range)
FNGL are associated with unfavorable clinical phenotype. This subset of LN requires further studies targeting its outcomes and optimal treatment.