Lesiones renales en el lupus eritematoso diseminado: ausencia de relación entre datos clínicos e histológicos / Kidney injury in systemic lupus erythematosus: lack of correlation between clinical and histological data

ANTECEDENTES: La presencia y patrón morfológico del compromiso renal afecta el pronóstico del lupus eritematoso sistémico, información que puede ser indispensable para tomar decisiones terapéuticas apropiadas. OBJETIVO: Evaluar relación estadística entre datos clínicos e histológicos en pacientes con nefropatía lúpica biopsiada. MÉTODOS: Revisión de información clínica en solicitudes de biopsias renales de adultos, informadas entre 2002 y 2014, con diagnóstico clínico e histopatológico inequívoco de compromiso renal por lupus eritematoso sistémico. RESULTADOS: Ciento treinta y cuatro casos (86% mujeres), edad 15-59 años. Cuadro clínico: 30% alteraciones urinarias asintomáticas, 9% proteinuria nefrótica sin hipoalbuminemia, 19% síndrome nefrótico y 40% por insuficiencia renal, existiendo 2 casos sin manifestaciones clínicas renales. Las lesiones más frecuentes fueron proliferativas puras (68%). De los que tenían alteraciones urinarias asintomáticas, 35% eran clase IV, 30% clase III, 23% mixtas, 10% clase V y 2% clase II. Entre los de proteinuria nefrótica, 75% clase IV, 17% mixtas y 8% III. De los de síndrome nefrótico, 46% clase IV, 27% V, 19% mixtas y 8% clase III. Entre los de insuficiencia renal, el 67% eran IV, 22% mixtas, 7% III y 4% V. Estas proporciones no fueron estadísticamente diferentes. Aunque la peor función renal fue observada en la clase IV, casi la mitad (44%) de aquellos sin insuficiencia renal eran de esta misma clase. CONCLUSIÓN: No se demuestra una relación clínico-histológica consistente que permita predecir los patrones ni la gravedad de los hallazgos histológicos a partir del cuadro clínico en el lupus eritematoso sistémico con manifestaciones renales. Esos resultados refuerzan la importancia de la biopsia como herramienta diagnóstica fundamental en esta enfermedad

BACKGROUND: The existence and type of renal involvement influences the prognosis of systemic lupus erythematosus and this information may be critical when it comes to taking appropriate therapeutic decisions. OBJECTIVE: To evaluate statistical correlations between clinical and histological data in patients with biopsied lupus nephropathy. METHODS: Review of clinical information in adult kidney biopsy requests reported between 2002 and 2014 with a definitive clinical and histopathological diagnosis of renal involvement in systemic lupus erythematosus. RESULTS: 134 cases (86% women), aged 15-59 years. Indication for renal biopsy: asymptomatic urinary abnormalities (30%), nephrotic proteinuria without hypoalbuminaemia (9%), nephrotic syndrome (19%), renal failure (40%) and two cases without clinical renal manifestations. The most common lesions were purely proliferative (68%). In patients with asymptomatic urinary abnormalities, 35% were class IV, 30% class III, 23% mixed, 10% class V and 2% class II. In subjects with nephrotic proteinuria, 75% were class IV, 17% mixed and 8% class III. In nephrotic syndrome patients, 46% were class IV, 27% class V, 19% mixed and 8% class III. In renal failure subjects, 67% were class IV, 22% mixed, 7% class III and 4% class V. These proportions were not statistically different. Although class IV showed the worst renal function, almost half (44%) of those without renal failure belonged to this class. CONCLUSION: We could not demonstrate a consistent clinical-pathological relationship that predicts patterns or severity of histological findings based on the clinical profile in patients with systemic lupus erythematosus and renal manifestations. These results highlight the importance of biopsy as a key diagnostic tool in this disease

Kidney injury in systemic lupus erythematosus: lack of correlation between clinical and histological data. / Lesiones renales en el lupus eritematoso diseminado: ausencia de relación entre datos clínicos e histológicos.

BACKGROUND: The existence and type of renal involvement influences the prognosis of systemic lupus erythematosus and this information may be critical when it comes to taking appropriate therapeutic decisions. OBJECTIVE: To evaluate statistical correlations between clinical and histological data in patients with biopsied lupus nephropathy. METHODS: Review of clinical information in adult kidney biopsy requests reported between 2002 and 2014 with a definitive clinical and histopathological diagnosis of renal involvement in systemic lupus erythematosus. RESULTS: 134 cases (86% women), aged 15-59 years. Indication for renal biopsy: asymptomatic urinary abnormalities (30%), nephrotic proteinuria without hypoalbuminaemia (9%), nephrotic syndrome (19%), renal failure (40%) and two cases without clinical renal manifestations. The most common lesions were purely proliferative (68%). In patients with asymptomatic urinary abnormalities, 35% were class IV, 30% class III, 23% mixed, 10% class V and 2% class II. In subjects with nephrotic proteinuria, 75% were class IV, 17% mixed and 8% class III. In nephrotic syndrome patients, 46% were class IV, 27% class V, 19% mixed and 8% class III. In renal failure subjects, 67% were class IV, 22% mixed, 7% class III and 4% class V. These proportions were not statistically different. Although class IV showed the worst renal function, almost half (44%) of those without renal failure belonged to this class. CONCLUSION: We could not demonstrate a consistent clinical-pathological relationship that predicts patterns or severity of histological findings based on the clinical profile in patients with systemic lupus erythematosus and renal manifestations. These results highlight the importance of biopsy as a key diagnostic tool in this disease.