Venous thromboembolism (VTE) among patients with lupus nephritis (LN) is not limited to those with class 5 disease, but extends to those with class 3 or 4 disease, according to recent study findings.

In addition, investigators found that age may modulate LN class-specific VTE risk.

In a cohort of 534 patients with LN, 310 (58%) had class 3 or 4 disease and 224 (42%) had class 5 with or without class 3 or 4 (including 106 with pure class 5 disease). VTE occurred in 62 patients (11.6%) and included deep vein thrombosis (DVT), pulmonary embolism (PE), and superficial VTE (eg, fistula or graft thromboses).

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The odds of VTE did not differ significantly between patients with class 3 or 4 LN and patients with any class 5 disease, corresponding author Saira Z. Sheikh, MD, of the Thurston Arthritis Research Center at the University of North Carolina in Chapel Hill, and colleagues reported in Kidney International Reports. The investigators obtained the similar results in sensitivity analyses using only pure class 5 as the comparator.

In addition, the investigators observed an age effect: 2.75-fold increased odds of VTE at younger ages (estimated at age 16 years) for patients with class 3 or 4 LN compared with class 5. Older patients (estimated at age 46 years) with class 3 or 4 vs class 5 LN had 77% decreased odds of VTE.

According to Dr Sheikh’s team, knowing the class-specific effects of LN on VTE risk could help risk-stratify the need for VTE prophylaxis, anticoagulation duration, and diagnostic testing among patients with systemic lupus erythematosus. They suggested that the effects of LN on VTE risk may be mediated by different mechanisms in class 3 or 4 than in class 5. Alternately, increased VTE risk may be associated with disease duration, immunosuppression, infection, hospitalization, or kidney disease progression. With respect to study limitations, the investigators noted they could not control for disease duration and severity and differences in medication and management between LN classes.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Cooley I, Derebail VK, Gibson KL, et al, on behalf of the Chapel Hill Alliance Promoting Excellence in Lupus (CHAPEL) group of investigators. Association of lupus nephritis histopathologic classification with venous thromboembolism – modification by age at biopsy. Published online February 25, 2021. Kidney Int Rep. doi:10.1016/j.ekir.2021.02.015