Background: Wire-loop lesion (WL) is one of the active lesions of lupus nephritis (LN). However, few reports have focused on the clinicopathological relationships of WL to serological immune abnormality and renal prognosis.
Methods: We enrolled 126 Japanese LN patients subjected to renal biopsy in 11 hospitals from 2000 to 2018. In patients with class III or IV of the International Society of Nephrology/Renal Pathology Society classification, we retrospectively compared clinicopathological findings between those with WL (WL+ group) and without WL (WL- group) to detect factors associated with WL. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate of <60 mL/min/1.73m2 for more than three months. We also compared these findings between those with CKD (CKD+ group) and without CKD (CKD- group) at the last visit to investigate factors associated with renal prognosis.
Results: Of 126 patients, 100 (79.4%) were classified as class III or IV. WL was found in 36 (36.0%) of them. Although the renal function did not differ, the WL+ group had a higher titre of serum anti-dsDNA antibodies and lower serum complement 3 levels than the WL- group. Linear regression analysis revealed a significant association only between anti-dsDNA antibodies and WL (β = 0.27, 95% confidence interval (CI) 0.001-0.100, p = 0.01). Of these patients, 69 were tracked for 59.6 ± 55.1 months. Kaplan-Meier analysis showed no difference in renal prognosis between these groups. Next, the CKD+ group included 15 (22.1%) patients. They were older and had higher frequencies of hypertension and hyperuricaemia, serum creatinine (Cr) level, glomerulosclerosis, interstitial inflammation, interstitial fibrosis and tubular atrophy than the CKD- group at the time of renal biopsy. The frequency of WL was not significantly different. Cox regression analysis revealed significant associations of CKD with hypertension, hyperuricaemia, serum Cr level at the time of renal biopsy clinically and with tubular atrophy histologically.
Conclusions: WL was associated with serum anti-dsDNA antibodies but not with renal prognosis, suggesting that WL reflects immune abnormality but is not an independent factor predictive of renal prognosis in LN.
Keywords: Active lesions; anti-dsDNA antibodies; lupus nephritis; prognosis; wire-loop lesion.
Interstitial inflammation and interstitial fibrosis and tubular atrophy predict renal survival in lupus nephritis.Clin Kidney J. 2018 Apr;11(2):207-218. doi: 10.1093/ckj/sfx093. Epub 2017 Aug 31. Clin Kidney J. 2018. PMID: 29644061 Free PMC article.
Analysis of clinicopathologic correlations in Iranian patients with lupus nephritis.Int J Rheum Dis. 2013 Dec;16(6):731-8. doi: 10.1111/1756-185X.12059. Epub 2013 May 28. Int J Rheum Dis. 2013. PMID: 24382282
Epidemiology and risk factors for chronic kidney disease in Chinese patients with biopsy-proven lupus nephritis.Intern Med J. 2015 Nov;45(11):1167-72. doi: 10.1111/imj.12840. Intern Med J. 2015. PMID: 26109241
Long-term renal outcomes in multi-ethnic Southeast Asians with lupus nephritis: a retrospective cohort study.Intern Med J. 2018 Sep;48(9):1117-1123. doi: 10.1111/imj.13960. Intern Med J. 2018. PMID: 29740923
Molecular and Immunological Basis of Tubulo-Interstitial Injury in Lupus Nephritis: a Comprehensive Review.Clin Rev Allergy Immunol. 2017 Apr;52(2):149-163. doi: 10.1007/s12016-016-8533-z. Clin Rev Allergy Immunol. 2017. PMID: 26961386 Review.