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Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset
KEY POINTS: Non-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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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American Society of Nephrology
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10371271/ https://www.ncbi.nlm.nih.gov/pubmed/37257088 http://dx.doi.org/10.34067/KID.0000000000000161 |
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author | Ye, Julia Croom, Nicole Troxell, Megan L. Kambham, Neeraja Zuckerman, Jonathan E. Andeen, Nicole Dall’Era, Maria Hsu, Raymond Walavalkar, Vighnesh Laszik, Zoltan G. Urisman, Anatoly |
author_facet | Ye, Julia Croom, Nicole Troxell, Megan L. Kambham, Neeraja Zuckerman, Jonathan E. Andeen, Nicole Dall’Era, Maria Hsu, Raymond Walavalkar, Vighnesh Laszik, Zoltan G. Urisman, Anatoly |
author_sort | Ye, Julia |
collection | PubMed |
description | KEY POINTS: Non-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. BACKGROUND: Renal 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. METHODS: From 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. RESULTS: NFH 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. CONCLUSIONS: NFH 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. |
format | Online Article Text |
id | pubmed-10371271 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Society of Nephrology |
record_format | MEDLINE/PubMed |
spelling | pubmed-103712712023-08-03 Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset Ye, Julia Croom, Nicole Troxell, Megan L. Kambham, Neeraja Zuckerman, Jonathan E. Andeen, Nicole Dall’Era, Maria Hsu, Raymond Walavalkar, Vighnesh Laszik, Zoltan G. Urisman, Anatoly Kidney360 Original Investigation KEY POINTS: Non-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. BACKGROUND: Renal 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. METHODS: From 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. RESULTS: NFH 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. CONCLUSIONS: NFH 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. American Society of Nephrology 2023-05-31 /pmc/articles/PMC10371271/ /pubmed/37257088 http://dx.doi.org/10.34067/KID.0000000000000161 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Original Investigation Ye, Julia Croom, Nicole Troxell, Megan L. Kambham, Neeraja Zuckerman, Jonathan E. Andeen, Nicole Dall’Era, Maria Hsu, Raymond Walavalkar, Vighnesh Laszik, Zoltan G. Urisman, Anatoly Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset |
title | Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset |
title_full | Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset |
title_fullStr | Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset |
title_full_unstemmed | Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset |
title_short | Non-Full House Membranous Lupus Nephritis Represents a Clinically Distinct Subset |
title_sort | non-full house membranous lupus nephritis represents a clinically distinct subset |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10371271/ https://www.ncbi.nlm.nih.gov/pubmed/37257088 http://dx.doi.org/10.34067/KID.0000000000000161 |
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