Poor compliance linked to catastrophic progression to end-stage kidney disease in lupus nephritis

Patients with lupus nephritis who had poor compliance and histopathologic features incluading thrombotic microangiopathy, collapsing glomerulopathy, and concomitant anti-glomerular basement membrane (anti-GBM) nephropathy were more likely to experience catastrophic progression to end-stage kidney disease (ESKD), according to a study.

This study included 10 with lupus nephritis who developed ESKD within 3 years of initial diagnosis, for a total of 1.8% of the total LN population. Researchers reviewed the pathology reports for distinct histopathologic features, as well as demographic, clinical, laboratory, and therapeutic variables.

The mean time to ESKD was 19.2 ± 12.4 months. The median rate of kidney function decline was more than 43 ml/min/1.73m2 per year.

Patients included had LN class III (n = 1), class IV (n = 5), membranous LN/class V (n = 2), and mixed IV/V (n = 2). Extensive thrombotic microangiopathy occurred in 2 patients, 1 with collapsing glomerulonephritis and 1 with concomitant anti-glomerular basement membrane (anti-GBM) nephropathy.

Severe non-compliance, which included stopping all medication to follow alternative treatments, was noted in 4 patients.

Reference
Tselios K, Gladman DD, Taheri C, et al. Factors Associated with Rapid Progression to End Stage Kidney Disease in Lupus Nephritis. J Rheumatol. 2020:jrheum.200161. DOI: 10.3899/jrheum.200161. Epub ahead of print. PMID: 33259331.