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Published on: June 8, 2022
Clinicopathological Characteristics and Outcomes of Lupus Nephritis Patients With Thrombocytopenia: A Single-Center
Hui Diao1,2, Yuting Fan1,2, Di Kang1,2
1Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Insights
Thrombocytopenia in lupus nephritis (LN) patients indicates higher disease activity and specific biopsy findings. However, it does not impact overall survival or renal outcomes, though anemia is a risk factor for death.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus.
- Thrombocytopenia is a common hematologic abnormality in autoimmune diseases.
- Understanding the clinical characteristics and prognosis of LN patients with thrombocytopenia is crucial.
Purpose of the Study:
- To analyze and summarize the clinical characteristics and prognosis of lupus nephritis patients with thrombocytopenia.
- To improve the understanding and management of this specific patient subgroup.
Main Methods:
- Retrospective analysis of clinical and pathological data from 896 LN patients.
- Comparison of LN patients with and without thrombocytopenia.
- Cox regression model to identify risk factors for mortality and adverse renal outcomes.
Main Results:
- 7.8% of LN patients had thrombocytopenia.
- Thrombocytopenic LN patients exhibited lower eGFR, higher SLE-DAI, anemia, leukopenia, hypocomplementemia, and anti-cardiolipin antibodies.
- Kidney biopsies showed higher activity index and more active features in thrombocytopenic patients.
- No significant difference in patient or renal survival between groups.
- Anemia and lower eGFR were risk factors for death and adverse renal outcomes, respectively.
Conclusions:
- LN patients with thrombocytopenia present with increased disease activity and specific biopsy findings.
- Prognosis regarding survival and renal outcomes was similar between LN patients with and without thrombocytopenia.
- Anemia identified as a significant risk factor for mortality in LN patients with thrombocytopenia.
Objectives:
The objective of this study is to analyze and summarize the clinical characteristics and prognosis of lupus nephritis (LN) patients with thrombocytopenia and to improve the cognition of the disease.
Methods:
896 LN patients were enrolled in this study and their clinical and pathological data were collected and analyzed. The primary end point was mortality. The secondary end point was adverse renal outcomes, defined as doubling of the baseline serum creatinine or end-stage renal diseases. Cox regression model was used to analyze the risk factors of mortality or renal events in LN with and without thrombocytopenia.
Results:
Among 896 LN patients, 70 (7.8%) were diagnosed with thrombocytopenia. LN patients with thrombocytopenia had lower estimated glomerular filtration rate (eGFR) and higher systemic lupus erythematosus disease activity index (SLE-DAI), proportion of anemia, leukopenia, hypocomplementemia, and positive anti-cardiolipin antibodies, compared to those without thrombocytopenia. LN patients with thrombocytopenia had higher scores of activity index and more activity features (endocapillary hypercellularity, medullary loop necrosis) on kidney biopsy. There was no significant difference in patient survival and renal survival between LN patients with and without thrombocytopenia. Anemia was a risk factor for death in LN patients with thrombocytopenia and lower eGFR was a risk factor for adverse renal outcomes.
Conclusions:
LN patients with thrombocytopenia showed higher disease activity, more anti-cardiolipin antibody positivity and a higher activity index in kidney biopsy, but the prognosis was similar compared with those without thrombocytopenia. Anemia was a risk factor for death in LN patients with thrombocytopenia.
