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Vascular lesions in lupus nephritis
E Grishman1, V S Venkataseshan
1Department of Pathology, Mount Sinai School of Medicine, City Hospital Center Elmhurst, New York, New York.
Summary
Vascular deposits in kidney small arteries are rare in systemic lupus erythematosus (SLE), but can indicate more severe disease. Treatment may lead to lesion resolution or sclerosis.
Area of Science:
- Nephrology
- Pathology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) can affect various organs, including the kidneys.
- Vascular lesions in small arteries and arterioles are a potential complication in SLE patients.
- Understanding the nature and prevalence of these lesions is crucial for patient management.
Purpose of the Study:
- To investigate the histologic evidence of vascular lesions in small arteries and arterioles in kidney specimens from patients with SLE.
- To compare the prevalence and characteristics of these lesions in different patient groups based on treatment history.
- To explore the association between vascular deposits and disease severity or clinical course.
Main Methods:
- Examination of kidney specimens from three groups: pre-steroid autopsy (n=24), post-steroid/immunosuppressant autopsy (n=26), and renal biopsies (n=276).
- Histologic evaluation for subendothelial eosinophilic deposits and necrotizing arteritis.
- Electron microscopy and immunofluorescence microscopy (IgG, IgA, IgM) were used for detailed characterization.
- Comparison with non-lupus patients with vascular lesions.
Main Results:
- Characteristic subendothelial eosinophilic deposits were found in 8/24 (pre-steroid) and 5/26 (post-steroid) autopsy cases.
- Resorption of deposits was noted in 3 post-steroid cases; sclerosis was observed, particularly with treatment.
- Vascular deposits were present in 19/276 (6.9%) renal biopsies; thrombotic microangiopathy in 2.
- Immunofluorescence showed mixed IgG, IgA, and IgM in 7 SLE cases, not seen in controls.
- Vascular deposits were more common in male patients and associated with more severe glomerular disease and clinical course.
Conclusions:
- Vascular deposits in small arteries/arterioles are generally rare in SLE but can be present.
- These lesions may evolve, showing resorption or sclerosis, especially with steroid/immunosuppressant therapy.
- The presence of vascular deposits correlates with more severe kidney disease and a poorer clinical outcome in SLE patients.