TY - JOUR
T1 - Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset
AU - Ye, Julia
AU - Croom, Nicole
AU - Troxell, Megan L.
AU - Kambham, Neeraja
AU - Zuckerman, Jonathan E.
AU - Andeen, Nicole
AU - Dall'Era, Maria
AU - Hsu, Raymond
AU - Walavalkar, Vighnesh
AU - Laszik, Zoltan G.
AU - Urisman, Anatoly
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Key PointsNon-full house (NFH) membranous lupus nephritis (MLN) is a minor subset of all MLN cases.Patients with NFH MLN tend to be older when diagnosed with systemic lupus erythematosus, undergo first renal biopsy at an older age, and have fewer extrarenal systemic manifestations.Lower load of C3 glomerular deposits seen in NFH MLN biopsies suggests attenuation of complement-mediated injury, which may have wider systemic implications.BackgroundRenal involvement in systemic lupus erythematosus (SLE) is a key predictor of morbidity and mortality. Immunofluorescence (IF) staining of glomeruli is typically positive for IgG, IgA, IgM, C3, and C1q - the full house (FH) pattern. However, a subset of patients with membranous lupus nephritis (MLN) have a Non-FH (NFH) IF pattern more typical of idiopathic membranous nephropathy.MethodsFrom a multi-institutional cohort of 113 MLN cases, we identified 29 NFH MLN biopsies. NFH MLN was defined by IF criteria: ≥1+ glomerular capillary loop IgG staining and<1+ IgA, IgM, and C1q. FH MLN was defined as ≥1+ staining for all five antibodies. Intermediate (Int) cases did not meet criteria for FH or NFH. We compared the pathological and clinical characteristics and outcomes among patients with FH, NFH, and Int IF patterns on kidney biopsy.ResultsNFH MLN represents a subset of MLN biopsies (13.4%). Compared with patients with FH MLN, patients with NFH MLN were older at SLE diagnosis (29 versus 22.5 years), had a longer time to initial kidney biopsy (8 versus 3.16 years), and had fewer SLE manifestations (2.5 versus 3.36 involved systems). NFH MLN biopsies showed lower C3 IF intensity (1.16+ versus 2.38+). Int biopsies had findings intermediate between those of NFH and FH groups.ConclusionsNFH IF pattern defines a small subset of MLN biopsies and appears to be associated with milder clinical manifestations and slower disease progression. Less robust C3 deposition in NFH MLN may suggest a pathophysiology distinct from that of FH MLN.
AB - Key PointsNon-full house (NFH) membranous lupus nephritis (MLN) is a minor subset of all MLN cases.Patients with NFH MLN tend to be older when diagnosed with systemic lupus erythematosus, undergo first renal biopsy at an older age, and have fewer extrarenal systemic manifestations.Lower load of C3 glomerular deposits seen in NFH MLN biopsies suggests attenuation of complement-mediated injury, which may have wider systemic implications.BackgroundRenal involvement in systemic lupus erythematosus (SLE) is a key predictor of morbidity and mortality. Immunofluorescence (IF) staining of glomeruli is typically positive for IgG, IgA, IgM, C3, and C1q - the full house (FH) pattern. However, a subset of patients with membranous lupus nephritis (MLN) have a Non-FH (NFH) IF pattern more typical of idiopathic membranous nephropathy.MethodsFrom a multi-institutional cohort of 113 MLN cases, we identified 29 NFH MLN biopsies. NFH MLN was defined by IF criteria: ≥1+ glomerular capillary loop IgG staining and<1+ IgA, IgM, and C1q. FH MLN was defined as ≥1+ staining for all five antibodies. Intermediate (Int) cases did not meet criteria for FH or NFH. We compared the pathological and clinical characteristics and outcomes among patients with FH, NFH, and Int IF patterns on kidney biopsy.ResultsNFH MLN represents a subset of MLN biopsies (13.4%). Compared with patients with FH MLN, patients with NFH MLN were older at SLE diagnosis (29 versus 22.5 years), had a longer time to initial kidney biopsy (8 versus 3.16 years), and had fewer SLE manifestations (2.5 versus 3.36 involved systems). NFH MLN biopsies showed lower C3 IF intensity (1.16+ versus 2.38+). Int biopsies had findings intermediate between those of NFH and FH groups.ConclusionsNFH IF pattern defines a small subset of MLN biopsies and appears to be associated with milder clinical manifestations and slower disease progression. Less robust C3 deposition in NFH MLN may suggest a pathophysiology distinct from that of FH MLN.
KW - kidney biopsy
KW - kidney disease
KW - lupus nephritis
KW - membranous nephropathy
KW - nephrotic syndrome
KW - outcomes
KW - pathology
KW - renal pathology
KW - rheumatology
KW - systemic lupus erythematosus
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U2 - 10.34067/KID.0000000000000161
DO - 10.34067/KID.0000000000000161
M3 - Article
C2 - 37257088
AN - SCOPUS:85165880956
SN - 2641-7650
VL - 4
SP - 935
EP - 942
JO - Kidney360
JF - Kidney360
IS - 7
ER -