Renal Thrombotic Microangiopathy in Proliferative Lupus Nephritis: Risk Factors and Clinical Outcomes: A Case-Control Study

J Clin Rheumatol. 2016 Aug;22(5):235-40. doi: 10.1097/RHU.0000000000000425.


Background: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

MeSH terms

  • Adult
  • Antibodies, Antiphospholipid / analysis
  • Antirheumatic Agents / therapeutic use*
  • Biopsy / methods
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Kidney / pathology*
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / therapy
  • Lupus Nephritis* / diagnosis
  • Lupus Nephritis* / pathology
  • Lupus Nephritis* / physiopathology
  • Lupus Nephritis* / therapy
  • Lymphocyte Count / methods
  • Male
  • Mexico
  • Outcome and Process Assessment, Health Care
  • Patient Acuity
  • Prognosis
  • Renal Dialysis / methods*
  • Risk Factors
  • Thrombotic Microangiopathies* / pathology
  • Thrombotic Microangiopathies* / physiopathology


  • Antibodies, Antiphospholipid
  • Antirheumatic Agents