Renal pathology and clinical associations in systemic sclerosis: a historical cohort study
Authors Tonsawan P, Talabthong K, Puapairoj A, Foocharoen C
Received 1 July 2019
Accepted for publication 14 August 2019
Published 2 September 2019 Volume 2019:12 Pages 323—331
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Pantipa Tonsawan,1 Komkid Talabthong,1 Anucha Puapairoj,2 Chingching Foocharoen1
1Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Correspondence: Chingching Foocharoen
Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002 Thailand
Tel +66 4 336 3746
Background: The information guiding the treatment decision(s) for renal diseases in systemic sclerosis (SSc) is the renal pathological finding. This study aimed to evaluate the renal pathological diagnosis and its clinical feature among SSc.
Method: A historical cohort study was performed on adult Thai SSc patients who underwent renal biopsy during January 2005–December 2016. The renal pathologic findings and patient clinical characteristics were reviewed. Chi-square or Fisher’s exact test was applied to analyze the association between clinical manifestation and renal pathology.
Results: Of the 26 SSc patients identified (77% female), 46% had the diffuse cutaneous SSc subtype. The mean age at the time of biopsy was 53.2±14.4 years and median duration of disease was 2.4 years (IQR 0.5–7.0). Rapidly progressive glomerulonephritis (RPGN) was the most common renal manifestation (53.9%) followed by nephrotic syndrome (19.2%) and nephritis (11.5%). The pathological diagnosis included lupus nephritis (LN) class IV (26.9%), LN class V (19.2%), scleroderma renal crisis (SRC; 19.3%), progressive renal disease in scleroderma (7.7%), and IgA nephropathy (7.7%). The nephrotic syndrome was the most common renal feature among LN class V patients, whereas RPGN was the commonest renal presentation among LN class IV and SRC patients (p=0.001). Dialysis treatment at the time of kidney biopsy was significantly higher in SRC patients than in the other groups (p<0.001). The SRC tended to have more frequent cardiac involvement, pulmonary fibrosis, and shorter disease duration than the other groups.
Conclusion: This is the first report of renal pathologic findings in Thai SSc patients. RPGN is the commonest renal manifestation among SSc who underwent kidney biopsy; for whom LN was the most common pathological finding. Nephrotic syndrome is a clinical feature of glomerular diseases other than renal involvement in SSc.
Keywords: scleroderma, renal biopsy, glomerular disease, scleroderma renal crisis
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