Objective Patients with lupus nephritis (LN), including those below age 50, face significantly higher risk of atherosclerotic cardiovascular disease (ASCVD) vs. peers. This highlights the need for identifying specific ASCVD risk factors in LN. Renal arteriosclerosis in kidney biopsies (subclinical arteriosclerosis) may be able to predict future clinical ASCVD events. However, renal arteriosclerosis is under-reported in LN biopsies and is not taken into consideration when ASCVD risk is calculated. Therefore, we aimed to systematically grade renal arteriosclerosis in kidney biopsies at LN diagnosis and examined associations with 10- & 20-year ASCVD occurrence. Methods Adults with biopsy proven LN were included. Clinical ASCVD, including fatal & non-fatal events, were adjudicated. Utilizing standard Banff grading criteria, all biopsies at LN diagnosis were re-read to grade renal arteriosclerosis. Covariables (e.g., socio-demographics, comorbidities, med exposure) were abstracted. Using Cox models, factors (including renal arteriosclerosis) associated with 10- & 20-year clinical ASCVD were examined. Results Among 209 patients, 36 & 49 clinical ASCVD occurred within 10 & 20 years. Renal arteriosclerosis (>25%) was associated with 3x higher 10-year ASCVD. High area deprivation index (>80) & longer angiotensin converting enzyme inhibitor (ACEi) exposure were associated with 4x higher & 0.65x lower ASCVD occurrence. Adding renal arteriosclerosis >25% improved model performance for 10-year ASCVD risk estimation from 65% to 80%. Similar associations were seen with 20-year ASCVD. Conclusion Renal arteriosclerosis >25%, area deprivation, ACEi exposure could inform ASCVD risk stratification in LN. Prospective studies should validate findings and inform clinical use.

中文翻译：

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狼疮性肾炎中肾活检中肾动脉硬化与高级 10 年动脉粥样硬化性心血管疾病相关


目的 狼疮性肾炎 （LN） 患者，包括 50 岁以下的患者，与同龄人相比，动脉粥样硬化性心血管疾病 （ASCVD） 的风险显著升高。这突出了在 LN 中识别特定 ASCVD 危险因素的必要性。肾活检中的肾动脉硬化（亚临床动脉硬化）可能能够预测未来的临床 ASCVD 事件。然而，肾动脉硬化在 LN 活检中漏报，在计算 ASCVD 风险时未予考虑。因此，我们的目标是在LN诊断时系统地对肾活检中的肾动脉硬化进行分级，并检查与10年和20年ASCVD发生的关联。方法 纳入活检证实 LN 的成人。临床ASCVD，包括致命和非致命事件，都被判定为异常。利用标准的 Banff 分级标准，重新读取 LN 诊断时的所有活检以对肾动脉硬化进行分级。协变量 （例如，社会人口统计学、合并症、药物暴露） 被抽象出来。使用Cox模型，检查了与10年和20年临床ASCVD相关的因素（包括肾动脉硬化）。结果 在209名患者中，有36名和49名临床ASCVD发生在10年和20年内。肾动脉硬化 （>25%） 与 10 年 ASCVD 高 3 倍相关。高区域剥夺指数（>80）和较长的血管紧张素转换酶抑制剂（ACEi）暴露与ASCVD发生率高4倍和低0.65倍有关。添加肾动脉硬化 >25% 将 10 年 ASCVD 风险评估的模型性能从 65% 提高到 80%。与 20 年 ASCVD 也存在类似的关联。结论 肾动脉硬化 >25% 、区域剥夺、ACEi 暴露可指导 LN 患者 ASCVD 风险分层。前瞻性研究应验证结果并为临床应用提供信息。