Lupus and IgA nephropathy: coexistence or coincident?

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Background:

• Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease.
• Lupus nephritis is the most common renal pathology in SLE patients.
• Non-lupus nephropathies, such as IgA nephropathy, can also occur in SLE.

Purpose of the Study:

• To evaluate clinical features and outcomes of SLE patients with IgA nephropathy.
• To compare these outcomes with primary IgA nephropathy and lupus nephritis cohorts.

Main Methods:

• Comprehensive literature review of PubMed and Google Scholar (1995-2023).
• Inclusion of 16 reported cases and 2 new cases of SLE with IgA nephropathy.
• Comparison with 47 lupus nephritis and 215 primary IgA nephropathy patients.

Main Results:

• 18 cases of SLE with IgA nephropathy identified (median age 41.6, 72.2% female).
• Lower renal failure (11.1% vs. 34%) and mortality (5.6% vs. 20%) in SLE-IgA nephropathy vs. primary IgA nephropathy.
• Slightly lower mortality in SLE-IgA nephropathy vs. lupus nephritis (5.6% vs. 10.6%).

Conclusions:

• SLE with IgA nephropathy typically follows a more indolent course than primary IgA nephropathy.
• Severe cases, particularly with crescentic glomerulonephritis, can still lead to renal failure.
• SLE patients with IgA nephropathy demonstrate a more favorable prognosis compared to primary IgA nephropathy.