Bowman’s capsule rupture may be an important marker of pathologic changes and high risk for end-stage kidney disease (ESKD) in patients with lupus nephritis (LN), according to investigators.

“To our knowledge, this study for the [first] time provides a comprehensive description of the role of Bowman’s capsule rupture in patients with LN, showing that Bowman’s capsule rupture is associated to more serious clinical and pathological manifestations as well as poor prognosis,” the authors wrote in the Journal of Nephrology.

In a study of 180 patients with LN, 52 (28.9%) had Bowman’s capsule rupture on light microscopy of renal biopsy specimens (defined as discontinuity in the wall surrounding the glomerulus), and 128 (71.1%) did not. The group with vs without Bowman’s capsule rupture had high serum creatinine and 24-hour urinary protein levels and activity/chronicity index, Lin Sun, MD, PhD, and colleagues from The Second Xiangya Hospital, Central South University, Changsha, Hunan, China, reported. Bowman’s capsule rupture correlated with adverse pathology including crescent level, tubular atrophy, and interstitial fibrosis. The group with vs without Bowman’s capsule rupture also displayed a higher number of CD20+ cells.

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After a median follow-up of 48.9 months, 6.0% of patients progressed to ESKD. The group with vs without Bowman’s capsule rupture had significantly lower ESKD-free survival. The quartile 4 group of Bowman’s capsule rupture had significantly lower ESKD-free survival compared with quartiles 1-3.

In a multivariable Cox regression analysis, a high serum creatinine and activity index and a greater proportion of glomeruli with Bowman’s capsule rupture significantly predicted a 39.6-, 1.5, and 1.1-fold increased risk for progression to ESKD, respectively, the investigators reported. Among patients with vs without crescents, the presence of Bowman’s capsule rupture (which included at least 1 crescent, by definition) was significantly associated with lower ESKD-free survival.

“Bowman’s capsule rupture is an important renal pathological lesion, which correlates with severe clinical manifestations, pathological changes, and poor prognosis in patients with lupus nephritis,” Dr Sun’s team concluded. The investigators were unable to determine the effect of steroids and immunosuppressive agents on Bowman’s capsule rupture.


Duan T, Zhu X, Zhao Q, et al. Association of Bowman’s capsule rupture with prognosis in patients with lupus nephritis. J Nephrol. Published online April 18, 2022. doi:10.1007/s40620-022-01316-x