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The following is a summary of “Factors associated with worsening interstitial fibrosis/tubular atrophy in lupus nephritis patients undergoing clinically indicated repeat kidney biopsy,” published in the April 2025 issue of BMC Nephrology by Shao et al. 

Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE). Interstitial fibrosis/tubular atrophy (IFTA) on kidney biopsies predicts progression to end-stage renal disease, though its associated factors remain unclear. 

Researchers conducted a retrospective study to evaluate the demographic, clinical, and histopathological factors at index kidney biopsies associated with worsening IFTA on repeat biopsies.  

They identified patients with LN Class I to V or mixed LN on index biopsies who underwent a clinically indicated repeat biopsy between 2004 and 2020. None-mild IFTA was defined as < 25% of the interstitium affected, and moderate-severe IFTA was defined as ≥ 25% affected. Progressors were patients with none-mild IFTA on index biopsies who progressed to moderate-severe IFTA on repeat biopsies. Non-progressors were patients with none-mild IFTA on both biopsies. 

The results showed that 72 patients underwent repeat biopsies, with 35 (49%) identified as progressors. Progressors had a higher proportion of proliferative LN (26 [74%] vs. 18 [49%], P = 0.04) and crescents (9 [26%] vs. 3 [8%], P = 0.045) on index biopsies. No differences were found in the time to repeat biopsy or baseline characteristics, including eGFR, presence of hypertension and diabetes, urine protein to creatinine ratio, or initial treatments. 

Investigators found that proliferative LN and the presence of crescents on index biopsies were associated with subsequent IFTA progression. This suggested that glomerular damage drives tubulointerstitial scarring and may contribute to poor treatment response and progression to chronic kidney disease. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-025-04108-0