IMPACTO DA PRESENÇA DE MICROANGIOPATIA TROMBÓTICA NA AVALIAÇÃO HISTOPATOLÓGICA ENTRE PACIENTES COM NEFRITE LÚPICA PROLIFERATIVA

Víctor Mendes Ferreira; Ana Cecilia Alves Cardoso; Lara Gonçalves Sette; Gabriel Andrade de Araújo; David Campos Wanderley; Stanley de Almeida Araújo; Elisa do Carmo Viana; Josiane Santos Brant Rocha

doi:10.1590/SciELOPreprints.11948

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Víctor Mendes Ferreira Unidade de Terapia Renal Substitutiva de Januária https://orcid.org/0000-0001-5778-5062
Ana Cecilia Alves Cardoso Hospital Evangélico
Lara Gonçalves Sette Santa Casa BH
Gabriel Andrade de Araújo Santa Casa BH
David Campos Wanderley Instituto de Nefropatologia
Stanley de Almeida Araújo Instituto de Nefropatologia
Elisa do Carmo Viana Fundação Hospitalar Dilson Godinho
Josiane Santos Brant Rocha Montes Claros State University

DOI:

https://doi.org/10.1590/SciELOPreprints.11948

Keywords:

Lupus Nephritis, Thrombosis, Microcirculation, Anemia, Hemolytic, Pathology

Abstract

- Background and objective:

Among renal vascular lesions that can occur in patients with lupus there is thrombotic microangiopathy. Studies suggest an association between its presence and unfavorable prognosis. This study aimed to describe clinical and laboratory findings from patients with renal thrombotic microangiopathy concomitant with lupus nephritis, and compare disease severity and outcomes with patients without such lesion.

- Methods:

Retrospective unicentric study with proliferative lupus nephritis patients whose medical records and renal biopsy results from April 2019 to November 2022 were reviewed. Patients without thrombotic microangiopathy were selected for a control group in a 2:1 ratio with thrombotic microangiopathy cases. Outcomes included treatment response, progression to end-stage renal disease, doubling of serum creatinine and death. Follow-up was until December 2023.

- Results:

Nine patients had thrombotic microangiopathy (median age was 28 and women predominated). All of them had arterial/arteriolar involvement, but only five had glomerular thrombosis. Five patients had confirmed hemolysis. There was no significant difference in creatinine levels (p = 0,085), estimated glomerular filtration rate (p = 0,0963) or need of dialysis (p = 0,444). However, proteinuria was higher and more frequent among patients with thrombotic microangiopathy (p = 0,002). There was no significant difference in outcomes.

- Conclusion:

Low incidence of hemolysis highlights the importance of renal biopsy. Proteinuria was higher among patients with thrombotic microangiopathy and this has prognostic value. However, there was no significant association between such lesion and worse outcomes in this population.