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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Nephrology 2023
Materias:
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.
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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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