Background/Purpose: Conflicting studies have reported varying associations between tubulointerstitial inflammation (TII), tubulointerstitial damage (TID), and the long-term outcomes of lupus nephritis (LN), due to analyzing them separately despite their frequent coexistence. To address these discrepancies and explore the combined prognostic value of TII and TID, we aimed to investigate whether coexisting tubulointerstitial lesions predict chronic kidney disease (CKD) progression in LN patients.

Methods: Data from 175 LN patients, collected at the time of renal biopsy, were analyzed. Patients were stratified into two groups based on the presence or absence of coexisting TII/TID. Uni- and multivariable Cox proportional hazard regression models were utilized to identify independent risk factors for CKD in LN patients.

Results: Of 175 patients, 110 (62.9%) exhibited coexisting TII/TID, while 65 (37.1%) did not. Patients with coexisting TII/TID tended to be older and presented with higher levels of ESR and 24-hour proteinuria, as well as lower levels of eGFR and hemoglobin compared to those without coexisting TII/TID. Over a mean follow-up period of 89.9 months, CKD and end-stage renal disease occurred more frequently in patients with coexisting TII/TID. Notably, the presence of coexisting TII/TID was associated with a higher risk of CKD progression, with adjusted hazard ratios of 2.667 (95% CI: 1.333, 5.335, P = 0.006) for all LN patients, 3.265 (95% CI: 1.451, 7.345, P = 0.004) for those with class III, IV, and V LN, and 3.045 (95% CI: 1.289, 7.195, P = 0.011) for those with class III, IV, V LN, and eGFR ≥ 30 mL/min/1.73 m².

Conclusion: LN patients with coexisting TII/TID are at a heightened risk of kidney function deterioration at LN onset and subsequent development of CKD over the long term.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/coexisting-tubulointerstitial-inflammation-and-damage-is-a-risk-factor-for-chronic-kidney-disease-in-patients-with-lupus-nephritis/