Open AccessThe Spectrum of Renal Involvement in Patients With Inflammatory Myopathies
Author(s) -
Grégoire Couvrat-Desvergnes,
A. Masseau,
Olivier Benveniste,
Alexandra Bruel,
Baptiste Hervier,
JeanMarie Mussini,
David Buob,
Éric Hachulla,
Philippe Rémy,
Raymond Azar,
E. Mac Namara,
Brigitte MacGregor,
Laurent Daniel,
Adeline Lacraz,
T. de Broucker,
Philippe Rouvier,
P. Carli,
Maurice Laville,
Étienne Dantan,
M. Hamidou,
Anne Moreau,
Fádi Fakhouri
Publication year - 2014
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000000015
Subject(s) - medicine , acute kidney injury , kidney disease , nephrology , acute tubular necrosis , myoglobinuria , incidence (geometry) , kidney , rhabdomyolysis , physics , optics
Data regarding the incidence and outcome of renal involvement in patients with inflammatory myopathies (IM) remain scarce. We assessed the incidence and causes of acute kidney injury (AKI) and chronic kidney disease (CKD) in 150 patients with dermatomyositis, polymyositis, and antisynthetase syndrome followed in 3 French referral centers. Renal involvement occurred in 35 (23.3%) patients: AKI in 16 (10.7%), and CKD in 31 (20.7%) patients. The main cause of AKI was drug or myoglobinuria-induced acute tubular necrosis. Male sex, cardiovascular risk factors, cardiac involvement, and initial proteinuria >0.3 g/d were associated with the occurrence of AKI. The outcome of patients with AKI was poor: 13 (81%) progressed to CKD and 2 (12.5%) reached end-stage renal disease. In multivariate survival analysis, age at IM onset, male sex, a history of cardiovascular events, and a previous episode of AKI were associated with the risk of CKD. We also identified 14 IM patients who underwent a kidney biopsy in 10 nephrology centers. Renal pathology disclosed a wide range of renal disorders, mainly immune-complex glomerulonephritis. We identified in 5 patients a peculiar pattern of severe acute renal vascular damage consisting mainly of edematous thickening of the intima of arterioles. We found that AKI and CKD are frequent in patients with IM. Prevention of AKI is crucial in these patients, as AKI is a major contributor to their relatively high risk of CKD. A peculiar pattern of acute vascular damage is part of the spectrum of renal diseases associated with IM.