{
  "abstract": "Objectives Lupus nephritis (LN) remains a major determinant of morbidity and mortality in systemic lupus erythematosus (SLE). Kidney biopsy is essential to guide diagnosis, classification, and treatment decisions. However, limited data exist comparing histopathological differences in LN patients with native kidneys versus those who progressed to kidney transplantation (KT). The aim of this study was to evaluate and compare demographic, clinical, and histopathological features of patients with LN in native kidneys and those who underwent kidney transplantation.Methods We conducted a retrospective cohort study of patients with SLE who underwent kidney biopsy at our facility. Data were collected from April 2015 to April 2025. Patients were stratified into two groups: LN patients with biopsy-proven disease (n=125) and those with LN who subsequently underwent KT (LN/KT, n=26). Demographic, clinical, and histopathological parameters were compared, with particular attention to ISN/RPS LN class distribution, chronicity indices, and immunopathological features. Statistical analysis was performed using descriptive and comparative tests; p values <0.05 were considered statistically significant.Results The overall cohort demonstrated a female predominance with 113 females and 38 males (male-to-female ratio 1:3). LN/KT patients were younger at SLE diagnosis (19.8 ± 8.1 vs. 27.2 ± 8.6 years) and at biopsy (29 ± 9.6 vs. 33.7 ± 10.9 years). The most frequent biopsy classes overall were Class IV and Class V. LN/KT biopsies demonstrated a higher prevalence of sclerosed glomeruli (100% vs. 52.3%, p=0.0001), a greater mean percentage of sclerosis (34.3% vs. 20.2%, p=0.0096), and markedly higher chronicity scores (8 ± 3.7 vs. 2.8 ± 2.7, p=0.0001). Tubulointerstitial damage, including atrophy and fibrosis, was present in nearly all LN/KT patients. In contrast, endocapillary hypercellularity was significantly more common in the LN group. Chronicity index was the strongest predictor of progression to KT (OR 2.45, 95% CI 1.85–3.25, p<0.001).Conclusions This study highlights distinct clinicopathological features of LN patients who progressed to kidney transplantation compared with those with native kidney involvement. LN/KT patients demonstrated earlier disease onset, higher chronicity, greater glomerulosclerosis, and more extensive vascular pathology. Recognition of these high-risk biopsy features may guide earlier intervention strategies aimed at delaying progression to kidney failure and transplantation.",
  "authors": [
    {
      "affiliations": [
        "Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"
      ],
      "name": "Rajaie Namas"
    },
    {
      "affiliations": [
        "Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"
      ],
      "name": "Jad Mooty"
    },
    {
      "affiliations": [
        "Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"
      ],
      "name": "Sarah Al Qassimi"
    },
    {
      "affiliations": [
        "Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"
      ],
      "name": "Muriel Ghosn"
    },
    {
      "affiliations": [
        "Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates"
      ],
      "name": "Amir Malik"
    }
  ],
  "title": "PO:09:250 Comparative kidney biopsy analysis in lupus nephritis patients with and without transplantation",
  "uid": "a116a07a-dc05-56c5-b16b-4280ce1a63f1"
}