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Association of Bowman’s capsule rupture with prognosis in patients with lupus nephritis

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Abstract

Background and objective

Lupus nephritis is one of the most severe manifestations of systemic lupus erythematosus. The clinical and prognostic significance of Bowman’s capsule rupture in patients with lupus nephritis is unknown.

Methods

One hundred eighty patients with lupus nephritis were enrolled in the study and the integrity of Bowman’s capsule was assessed. Both inflammatory and proliferative cells were detected by immunochemistry staining. The primary events of interest were end-stage renal disease and death.

Results

After retrospective analysis of the data, 52 (28.9%) patients were found to have Bowman’s capsule rupture, which was accompanied by high levels of serum creatinine, 24 h urine protein, and Activity/Chronicity Index. Bowman’s capsule rupture was correlated with the level of crescents, tubular atrophy, and interstitial fibrosis. The number of CD20+ cells was higher in the Bowman’s capsule rupture ( +) group compared with the Bowman’s capsule rupture (−) group, while no differences in other inflammatory cells were observed. In addition, the end stage renal disease-free survival in the Bowman’s capsule rupture ( +) group was lower than in the Bowman’s capsule rupture (−) group. Moreover, serum creatinine (HR 39.56, P < 0.001), Activity Index (HR 1.50, P < 0.05) as well as Bowman’s capsule rupture (HR 1.09, P < 0.05) predicted end-stage renal disease progression. Notably, for patients with existing crescents, Bowman’s capsule rupture increased the cumulative risk of end-stage renal disease.

Conclusions

Bowman’s capsule rupture is an important renal pathological lesion, which correlates with severe clinical manifestations, pathological changes, and poor prognosis in patients with lupus nephritis.

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Acknowledgements

The authors are thankful to the physicians and nurses of the Second Xiangya Hospital, Central South University and patients who made it possible to conduct this study.

Funding

This work was supported by the Key Program of General Program of the National Natural Science Foundation of China (NSFC) (81730018).

Author information

Authors and Affiliations

  1. Department of Nephrology, The Second Xiangya Hospital, Central South University, Key Laboratory of Kidney Disease and Blood Purification, Changsha, Hunan, China

    Tongyue Duan, Xuejing Zhu, Qing Zhao, Li Xiao, Liyu He, Hong Liu, Anqun Chen, Shaobin Duan, Shuguang Yuan, Chengyuan Tang, Fang Yuan, Jianling Zhu, Xiaoping Zhu, Meichu Cheng, Yinghong Liu, Yu Liu, Fuyou Liu & Lin Sun

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  1. Tongyue Duan
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  2. Xuejing Zhu
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  3. Qing Zhao
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  4. Li Xiao
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  5. Liyu He
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  6. Hong Liu
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  11. Fang Yuan
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  18. Lin Sun
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Contributions

All authors contributed to the study conception and design. TD is the first author. LS obtained funding. TD, QZ, AC, CT, XZ, LS designed the study. LX, LH, HL, SD, SY, FY, JZ, XZ, MC, YiL, YuL and FL collected the data. TD, QZ, XZ cleaned and analyzed the data. TD drafted the manuscript. AC, SY and FL contributed to critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Lin Sun.

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Conflict of interest

All the authors declared no competing interests.

Ethical approval

The study complied with the Helsinki Declaration and was approved by the ethical review committee of The Second Xiangya Hospital, Central South University (Ethics approval number: 2021–072).

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Cite this article

Duan, T., Zhu, X., Zhao, Q. et al. Association of Bowman’s capsule rupture with prognosis in patients with lupus nephritis. J Nephrol 35, 1193–1204 (2022). https://doi.org/10.1007/s40620-022-01316-x

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  • DOI: https://doi.org/10.1007/s40620-022-01316-x

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