Risk factors for acute kidney injury and kidney relapse in patients with lupus podocytopathy

Abstract

Abstract Background Patients with lupus podocytopathy show a high incidence of acute kidney injury (AKI) and relapse, but the risk factors and mechanisms were unclear. This study analyzed the clinical-pathological features, and risk factors for AKI and relapse in lupus podocytopathy patients. Methods The cohort of lupus podocytopathy was generated by screening the biopsies of patients with lupus nephritis (LN) from 2002 to 2022, and was divided into the mild glomerular lesion (MGL) and FSGS groups based on glomerular morphological characteristics. The acute (ATI) and chronic (CTI) tubulointerstitial lesions were semi-quantitatively scored. Logistic and Cox regression was employed to identify the risk factors for AKI and relapse, respectively. Results Among 6 052 LN cases, 98 (1.6%) were diagnosed as lupus podocytopathy, with 71 in the MGL group and 27 in the FSGS group. All patients presented with nephrotic syndrome, and 33 (34.7%) of them had AKI. Seventy-seven (78.6%) patients achieved complete renal response (CRR) within 12 weeks of induction treatment, in which there was no difference in CRR rate between glucocorticoid monotherapy and combination therapy with glucocorticoids plus immunosuppressants. Compared to the MGL group, patients in the FSGS group had significantly higher incidences of hypertension and hematuria; in addition, they had higher SLEDAI-2 K, ATI and CTI scores, but a significantly lower CRR rate. Urinary protein ≥ 7.0 g/24 h and serum C3 ≤ 0.750 g/L were independent risk factors for AKI. During a median follow-up of 78 months, 57 cases (60.0%) had relapse, and none reached the kidney endpoint. Failure to achieve CRR within 12 weeks, maintenance with glucocorticoid monotherapy and AKI at onset were independent risk factors for the kidney relapse. Conclusions In this study, histological subtypes of lupus podocytopathy are found to be associated with clinical feature and treatment response;in addition, several risk factors associated with AKI occurrence and kidney relapse are identified.