Shivani Garg, MD, MS, on a Possible New Predictive Tool for CVD in Lupus Nephritis

Could renal arteriosclerosis be used as an early predictor of cardiovascular disease (CVD) in patients with lupus nephritis?

A study recently published in Arthritis Care & Research has examined the burden of renal arteriosclerosis in kidney biopsies obtained from patients with lupus nephritis and compared the prevalence to that in healthy kidney donors by age group. The researchers also sought to determine whether pathology reports underreport arteriosclerosis and its severity by using systematic Banff criteria on a subsample of biopsies from patients with lupus nephritis.

Of the 189 patients included in the study, renal arteriosclerosis was rendered prevalent 2 decades earlier in patients with lupus nephritis compared to patients without the disease. That meant it affected 40% of lupus nephritis patients 31-39 years old compared to 44% of patients without lupus nephritis at ages 50-59.

Shivani Garg, MD, MS, a rheumatologist and researcher at the University of Wisconsin School of Medicine and Public Health, served as first author of this study. Garg discussed the investigation and its findings with MedPage Today.

Why did you target arteriosclerosis in people with lupus nephritis?

Garg: Lupus patients with nephritis have a nine-fold higher risk of CVD and a two-fold higher risk of CVD or carotid plaques compared to lupus patients without nephritis. So there is an urgent need for early predictors of CVD to implement timely CVD prevention strategies.

Despite the literature suggesting that renal arteriosclerosis predicts CVD in other glomerulonephritis diseases, arteriosclerosis grading and reporting might be particularly overlooked in lupus nephritis biopsies. Our aim was to examine the burden of renal arteriosclerosis in lupus nephritis and assess whether arteriosclerosis is underreported.

What did you find?

Garg: Our study found that renal arteriosclerosis is common and accelerated by 2 decades in lupus patients in comparison to healthy donors. We found that lupus nephritis in patients 30 years of age or older strongly predicted the presence of renal arteriosclerosis.

We also found that renal arteriosclerosis reporting and grading in lupus biopsies was missed or overlooked in more than half of the routine pathology reports, because current guidelines lay no emphasis on universal reporting using standard criteria (such as Banff) for renal arterial changes.

What are the implications of your findings as far as addressing the need for early CVD predictors in this population?

Garg: This is the first study to examine the burden of renal arteriosclerosis in incident lupus nephritis patients using standard Banff interpretation and to compare its prevalence to healthy donors.

Our study underscored a need for universal use of systematic Banff renal arteriosclerosis grading criteria in all lupus biopsies, similar to transplant pathology reporting standards. Renal arteriosclerosis on pathology reports could be an early predictor of CVD in lupus nephritis patients.

What do you believe the future holds?

Garg: Future efforts will involve examining the correlation between renal arteriosclerosis and CVD occurrence in diverse cohorts.

Renal arteriosclerosis is now established as an early predictor of incident CVD events in IgA nephropathy, but a similar relationship in lupus nephritis patients is yet to be elucidated. Therefore, we plan to perform studies to grade renal arteriosclerosis in all lupus nephritis biopsies using a systematic renal arteriosclerosis grading criterion, such as Banff, and to examine its role as an early predictor of CVD events in lupus nephritis patients.

You can read an abstract of this study here and expert commentary about the clinical implications here.