Renal arteriosclerosis develops 2 decades earlier in patients with lupus nephritis (LN) than in age-matched healthy controls, according to a new study.

Age over 30 years and LN chronicity strongly predict renal arteriosclerosis among patients with LN. In addition, LN biopsy reports frequently lack information about renal arteriosclerosis, perhaps delaying implementation of measures to prevent cardiovascular disease (CVD).

Patients with LN have a 9-fold increased risk of CVD compared with healthy peers and 2-fold higher risk compared with patients who have systemic lupus erythematosus but not nephritis, lead investigator Shivani Garg, MD, MS, of the University of Wisconsin in Madison, explained in an interview with Renal & Urology News. “So, there is an urgent to find early predictors of CVD to implement timely CVD prevention strategies, such as renal arteriosclerosis that is shown to be an early predictor of CVD in IgA nephropathy,” Dr Garg said.

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She and her team identified 189 patients with incident LN who underwent kidney biopsies from 1994 to 2017 at their medical center. They interpreted LN biopsy reports to classify the Banff categories of none, mild, moderate, or severe renal arteriosclerosis. They compared the prevalence of renal arteriosclerosis with published prevalence data for 1203 age-matched healthy kidney donors and examined predictors of arteriosclerosis. A blinded study pathologist reviewed a 25% convenience sample of LN biopsies for Banff renal arteriosclerosis grading and compared findings to pathology reports.

Results showed a renal arteriosclerosis prevalence of 40% among patients with LN aged 31 to 39 years compared with 44% among the healthy donors aged 50 to 59 years, Dr Garg and her colleagues reported in Arthritis Care & Research. In the LN cohort, patients aged 30 years or older had significant 3.3-fold greater odds of renal arteriosclerosis than those younger than 30 years in adjusted analyses. In addition, compared with no LN chronicity on biopsy, the presence of LN chronicity was significantly associated with 4.0-fold increased odds of renal arteriosclerosis.

The study also found that renal arteriosclerosis reporting and grading in LN biopsies were missed or overlooked in more than half of the routine pathology reports, and the investigators attributed this to current International Society of Nephrology/Renal Pathology Society guidelines not providing recommendations on the standard use of systematic criteria to grade renal arteriosclerosis, such as Banff criteria, in all LN biopsies.

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“Our study underscores a need for universal use of systematic Banff renal arteriosclerosis grading criteria in all LN biopsies, similar to transplant pathology reporting standards,” Dr Garg said. 


Garg S, Bartels CM, Hansen KE, et al. High burden of premature arteriosclerosis on renal biopsies in incident lupus nephritis [published online January 7, 2020]. Arthritis Care Res.

doi: 10.1002/acr.24138