Renal vascular lesions in Childhood-onset Lupus Nephritis

Renal vascular lesions in Childhood-onset Lupus Nephritis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Renal vascular lesions in Childhood-onset Lupus Nephritis Ying Kit Lin, Eugene Yu-hin Chan, Yuen-fun Mak, Ming-chun To, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3988068/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Sep, 2024 Read the published version in Pediatric Nephrology → Version 1 posted 5 You are reading this latest preprint version Abstract Background: This study aimed to determine the clinical significance of renal vascular lesions (RVLs) in childhood-onset lupus nephritis (cLN). Methods: We retrospectively reviewed all children with biopsy-proven cLN between 2004-2020 to evaluate the prevalence of RVLs on kidney biopsy and its associated factors and long-term outcomes. The composite renal outcome was defined as advanced chronic kidney disease (CKD) stage 3-5, end-stage kidney disease (ESKD) and death. Results: 107 biopsies from 84 Chinese patients were analysed. RVLs were observed in 19 patients (22.6%), including non-inflammatory necrotizing vasculopathy (NNV, n=6), thrombotic microangiopathy (TMA, n=4), arterial sclerosis (AS, n=3), concurrent NNV with AS (n=4), concurrent NNV with TMA (n=1) and concurrent true renal vasculitis with AS (n=1). The presence of RVLs was associated with lower estimated glomerular filtration rate (eGFR) (66.9±40.3 vs 95.6±39.4ml/min/1.73m 2 , p=0.005), haemoglobin level (9.1±1.9 vs 10.4±1.9g/dL, p=0.008) and platelet count (150.1±96.4 vs 217.2±104.8 x 10 9 /L, p=0.01). LN classes and activity/chronicity indices were similar. Patients with RVLs had poorer composite renal outcomes, though not reaching statistical significance (log-rank test, p=0.06). The presence of NNV was associated with inferior survival free from composite renal outcome (log-rank test, p = 0.0018), compared to other forms of RVLs and those without RVLs. Univariate analysis revealed NNV (HR 7.08, 95% CI 1.67-30.03) was predictive of composite renal outcome. Conclusion: RVLs are present in one-fifth of cLN patients and are associated with severe presentation. NNV is associated with worse long-term renal outcome. Routine evaluation of RVLs is warranted and should be incorporated into future classification criteria. Renal vascular lesions childhood-onset lupus nephritis SLE systemic lupus erythematosus non-inflammatory necrotizing vasculopathy thrombotic microangiopathy Figures Figure 1 Figure 2 Figure 3 Introduction Kidney involvement is common in childhood-onset systemic lupus erythematosus (cSLE), occurring in around 50–80% of patients.[ 1 , 2 ] Around 4% of cSLE developed advanced chronic kidney disease (CKD).[ 2 , 3 ] Up to 15% of patients with childhood-onset lupus nephritis (cLN) may progress to end-stage kidney disease (ESKD),[ 4 , 5 ] and is also associated with significant morbidity and mortality, compared to general paediatric population.[ 6 ] Histopathological findings in LN are defined according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification. Prompt and accurate histological evaluation is important as it guides clinical management, since pathological findings are closely correlated to disease activity, treatment response and long-term renal outcomes.[ 7 ] Histopathological features in the ISN/RPS classification largely focus on glomerular and tubulointerstitial lesions, where renal vascular lesions (RVLs) are often overlooked. Renal vascular lesions (RVLs) in LN include arterial sclerosis (AS), non-inflammatory necrotizing vasculopathy (NNV), thrombotic microangiopathy (TMA), true renal vasculitis (TRV) and isolated immune complex deposits. Although the current ISN/RPS 2018 classification proposes standardized terminology and definition for RVLs, these findings have not been incorporated into the classification criteria.[ 8 ] While these lesions have been reported to be associated with clinical severity and adverse kidney outcomes in adult-onset LN, their role as an independent prognostic factor remains controversial.[ 9 , 10 ] cLN shows substantial differences in the disease pathogenesis, clinical presentation, epidemiology and outcomes compared to adult-onset LN.[ 5 ] There is also no currently available data pertaining to the clinical significance of RVLs in cLN. In view of such knowledge gap, this study was set forth to investigate the prevalence, associated factors and long-term outcomes of RVLs in biopsy-proven cLN. Methods Design and patients We conducted a retrospective cohort study at the Paediatric Nephrology Centre of Hong Kong Children’s Hospital, Hong Kong, which was formerly located at Princess Margaret Hospital. The Paediatric Nephrology Centre is the designated referral centre for complicated childhood kidney disorders and paediatric kidney replacement therapy. All Chinese children with biopsy-proven cLN diagnosed before 18 years of age, between 1st January 2004 and 31st December 2020, were identified and included for analysis. The minimum follow-up period following initial therapy was 12 months and patients with alternative diagnoses, such as overlap syndrome, were excluded from the analysis. The diagnosis of SLE was based on 1997 American College of Rheumatology criteria and/or 2012 Systemic Lupus International Collaborating Clinics group classification criteria. [ 11 , 12 ] Data retrieval and analysis was approved by the Central Institution Review Board of the Hospital Authority, Hong Kong (Reference no. PAED-2022-002). Renal histopathology Kidney biopsies were performed at the time of first renal presentation and in selected cases with severe kidney relapses. The kidney histology was either assessed or reviewed by the same experienced renal pathologist during the study period, and all biopsy samples were examined with light microscopy, immunofluorescence, and electron microscopy. Histology was classified according to the ISN/RPS 2003 classification.[ 7 ] Five types of RVL were carefully identified and reviewed[ 9 ]: 1) AS - thickening of arterial wall and narrowing of the lumen by intimal fibrosis and/or hyaline arteriosclerosis; 2) NNV - necrotizing changes in the vessel wall associate with abundant immune complex deposits, typically admixed with fibrin, without inflammation of the vessel wall, causing significant luminal narrowing or occlusion; 3) TMA - luminal narrowing or total occlusion by intraluminal, subendothelial or medial accumulation of eosinophilic, fuchsinophilic material with staining properties of fibrin, with the association of endothelial oedema and luminal thrombi; 4) TRV - prominent inflammatory cell infiltration of the arterial wall by neutrophils and mononuclear leukocytes; and 5) Isolated immune complex deposits (ICD) - Immunofluorescence study without corresponding changes on light microscopy. Isolated immune complex deposits, however, were difficult to evaluate due to retrospective assessment. Consequently, these patients with isolated immune complex deposits on immunofluorescence staining were excluded from the study. Therapy All patients received standard immunosuppressive therapy for cLN (induction treatments during the first 3 to 6 months of therapy, followed by a maintenance phase). Induction therapies for patients with proliferative LN (Class III, IV and mixed III/IV + V) comprised of high-dose oral prednisolone (0.8-1mg/kg/day), with or without intravenous pulse methylprednisolone (10-30mg/kg per dose for 3 doses, max. 1 gram/dose). The other induction agent included mycophenolate mofetil (MMF, 1200mg/m 2 /day), or in severe cases with intravenous cyclophosphamide (CYC), based on National Institutes of Health (0.5-1g/m 2 monthly for 6 months) or Euro-Lupus regimens (500 mg every 2 weeks for 3 months). Patients with severe membranous LN (class V) were managed with a combination of oral prednisolone and MMF. The maintenance immunosuppression included low-dose prednisolone (3-5mg/day) with either azathioprine (AZA, 1.5-2mg/kg/day) or MMF (600-1200mg/m2/day). Triple immunosuppressive therapy with corticosteroids, MMF and calcineurin inhibitors, or adjunctive treatments such as rituximab was offered to selected patients who were refractory to first-line treatments. Anti-malaria and/or renin-angiotensin-aldosterone system inhibitors were prescribed unless contraindicated. There was no specific treatment for RVLs except therapeutic plasmapheresis in the presence of severe TMA. Clinical evaluation Data pertaining to patient demographics, clinical manifestations and laboratory results were obtained through electronic medical systems. Estimated glomerular filtration rate (eGFR) was calculated with serum creatinine, by revised Schwartz Formula for patients younger than 18 years[ 13 ], and CKD-Epidemiology Collaboration (CKD-EPI) equation for 18 year-old patients.[ 14 ] Patients were followed every 1 to 8 weeks. Clinical parameters including blood pressure, urinalysis, physical examination findings were documented. Laboratory tests including complete blood count, renal biochemistry, anti-dsDNA, complement C3 levels and proteinuria were monitored regularly every 1 to 8 weeks. Outcomes The primary outcome was a composite renal outcome of advanced CKD (stage 3–5, eGFR < 60ml/min/1.73m 2 ), ESKD requiring maintenance kidney replacement therapy (KRT) and/or mortality. Secondary outcomes included prevalence, clinical presentations, treatment response and association factors for RVLs. Complete remission (CR) was defined by KDIGO guidelines as sustained early morning urinary protein-creatinine ratio (UPCR) = 50% and < 3mg/mg.[ 15 ] Both CR and PR required the stabilization or improvement in kidney function (± 10%~ 15% of baseline).[ 15 ] Statistical analysis Statistical analysis was performed by IBM SPSS Statistics version 26 software. When comparing the demographics, laboratory variables, histological differences and treatment regimens, Fisher exact test or Pearson’s chi square test was used for categorical variables while student’s t-test, Mann-Whitney U test or Kruskal-Wallis Test was used for continuous variables. Survival curve and survival pattern for composite-renal outcomes was generated by Kaplan-Meier method. Log-rank test was used to evaluate the difference in survival probability from the composite-renal outcomes in different groups. Univariate model was constructed with hazard ratio on individual factors with COX regression analysis. Results Ninety-six patients with cLN were identified, of which 12 patients were excluded from the study (Fig. 1 ). A total of 84 patients were included in the final analysis with 107 kidney biopsies performed. The median follow-up time was 10.2 years (IQR 5.7, 15.4) from LN diagnosis. RVLs were observed in biopsies of 19 patients (22.6%). Fourteen kidney biopsies with RVLs were performed at LN diagnosis, while another five were done during kidney flares. Patients with or without RVLs on kidney biopsy showed no difference in gender, age of LN diagnosis, proteinuria, anti-dsDNA, C3, SLEDAI score, and the autoantibodies profile (Table 1 ). Histological findings and clinical presentations Among the 19 patients with RVLs on kidney biopsy, six (31.6%) had isolated NNV, four (21.1%) had TMA and three (15.8%) had AS. Six patients had concurrent RVLs. Four patients (21.1%) had concurrent NNV and arterial sclerosis while one (5.3%) had both NNV and TMA in the same biopsy. The remaining one patient (5.3%) had both TRV and AS (Fig. 2 ). The clinical presentations of LN episodes at the time of kidney biopsies are shown in Table 2 . LN episodes with histological evidence of RVLs showed more severe renal manifestations, with higher serum creatinine (76 [Interquartile range IQR 55–174] vs 57 [IQR 46–79]µmol/l, p = 0.012), lower eGFR (66.9±40.3 vs 95.6±39.4 ml/min/1.73m 2 , p = 0.005) and higher risk of nephritic syndrome or stage 3 acute kidney injury (AKI) necessitating acute dialysis (57.9% vs 35.2%, p = 0.135). Haemoglobin (9.1±1.9 vs 10.4 ±1.9 g/dL, p = 0.008) and platelet levels (150.1 ± 96.4 vs 217.2 ± 104.8 x 10 9 /L, p = 0.012) were also lower in LN episodes with RVLs. Of note, the histological classification, activity index and chronicity scores were similar between LN episodes with or without RVLs (Table 3 ). Therapy A significantly higher proportion of patients with RVLs received CYC-MMF as initial-maintenance therapy (52.6% vs 15.9%, p = 0.002), and therapeutic plasmapheresis (26.3% vs 1.1%, p = < 0.001) compared to those without RVLs (Table 4 ). The main indication for plasma exchange is TMA. The use of rituximab was similar between the two groups. Short- and long-term kidney outcomes The complete, partial, and non-remission rates at 6- and 12-months were comparable between the two groups (Table 5 ). Patients with and without RVLs also had similar kidney relapse (RVL group 6.5 episodes per 100 patient-year vs non-RVL group 7.4 episodes per 100 patient-year, p value 0.69) (Table 5 ). At the last follow-up, the RVLs group had lower eGFR than the non-RVL group (95.1 ± 44.7 vs 114.1 ± 30.0 ml/min/1.73m 2, p value 0.046). There was no significant difference between both groups for serum creatinine and UPCR. (Table 5 ). Subgroup analysis further characterised RVLs into NNV and other forms of RVLs (non-NNV group). Patients with NNV, compared to non-NNV and non-RVL groups, had a significantly higher serum creatinine at last follow-up (102 [IQR 58–220] vs 62.5 [IQR 55–75] vs 55 [48, 64.5] µmol/l, p = 0.044). NNV group also had a lower eGFR (79.6±52.2 vs 116.3±18.6 vs 114.1±30.0 ml/min/1.73m2, p = 0.089) despite not reaching statistically significance. No clinical significance difference in proteinuria was observed in all three groups of patients. The RVL group was associated with an inferior survival free from composite renal outcomes, although it did not reach statistical significance (94.7% vs. 98.5%, 83.5% vs. 98.5%, 83.5% vs. 96.3% and 69.6% vs. 85.6% at 1-, 5, 10- and 15-years, respectively; p = 0.062 by log-rank test) (Fig. 3a). The NNV group showed a significantly worse survival free from composite renal outcomes when comparing to the non-NNV and non-RVL groups (log-rank p = 0.0018; Fig. 3b). The 1-, 5-, 10- and 15-year survival free from composite renal outcomes for NNV groups were 90.9%, 70.1%, 70.1% and 46.8%, respectively. Univariate analysis showed that the presence of NNV (HR 7.08, 95% CI 1.67–30.03), alongside with acute dialysis at presentation (HR 10.18, 95% CI 1.70–61.10), higher chronicity score at biopsy (HR 1.76, 95% CI 1.14–2.73) and non-remission at 12-months after treatment (HR 8.58, 95% CI 2.00–36.86) were associated with adverse kidney outcome. (Table 6 ) Discussion This is the first cohort study that reported the clinical epidemiology and significance of RVLs in cLN. In our study, RVLs were observed in 22.6% patients with cLN. Importantly, the presence of RVLs, in particular, NNV, was associated with more severe clinical presentations and worse long-term kidney outcomes. This highlights the importance of including RVL as a part of the routine assessments on kidney histology in cLN. Our results indicated that more than one-fifth of cLN patients showed RVLs on kidney biopsy. While cLN is often regarded as a more aggressive disease than adult-onset LN, the prevalence of RVLs in this study appeared to be lower than that in adults. This can be partly explained by the exclusion of ICD in our study. However, the prevalence of RVLs in adult-onset LN are highly variable (range between 28–82%) and the types of RVLs reported were also rather heterogeneous.[ 10 , 16 – 19 ] In our cohort, NNV and TMA were the most common RVLs on kidney biopsy in cLN. All currently available data on the types of RVLs in LN came from adult populations. While Wu et al. reported ICD represented 74.2% of RVLs, in other studies AS was observed in 24-57.8% of biopsies.[ 10 , 16 – 20 ] The highly varying prevalence of RVLs could be a result of different classification definitions, patient populations, disease severity and duration, and evaluation methods. NNV is distinguished from TRV by the absence of inflammatory cells in the blood vessel wall, and was the predominant RVL in our cohort, accounting for up to 57.9% of the RVLs. In adults, there is a considerable variation in its prevalence, ranging from 1.4 to 24%.[ 10 , 16 – 19 ] RVL may exist as an isolated vascular lesion, though co-existing with other RVLs is not uncommon.[ 21 ] Its pathogenesis remains unclear. Nevertheless, with the presence of abundant immune complex deposits consisting of immunoglobulin and complements in the vessel walls, some postulate that immunologic factor plays the main role of the evolution of NNV. It is also commonly associated with diffuse proliferative LN.[ 9 , 10 , 16 ] In addition, there may be extra-renal involvements such as cardiac, neurological, and retinal vasculopathy.[ 22 – 24 ] Indeed, the presence of NNV on kidney biopsy is clinically important, as one-third of our patients with NNV reached the composite renal outcome. Although half of these patients had co-existing AS, we believe these were likely to be the sequelae of the endothelial damage in necrotizing vasculopathy. Our data demonstrated that NNV was associated with worse long-term renal outcome. In the adult population, there is conflicting evidence over the impact of NNV on long-term renal outcome. Banfi et al. reported a lower 5-year renal survival in patients with NNV (68.1 ± 10.2% vs 89.6 ± 2.7%), compared to those without.[ 16 ] In contrast, Chu et al. and Mejia et al. did not observe such difference in kidney survival.[ 18 , 21 ] Another important form of RVL is TMA, which accounted for 26.3% of the RVLs in our patients. In LN, its prevalence is reported to be between 0.5 to 24%.[ 10 , 16 , 18 , 19 , 25 – 27 ] The causes of TMA in the setting of LN include anti-phospholipid syndrome (APLS), thrombotic thrombocytopenic purpura (TTP) and complement-mediated TMA. TMA could also be associated with infection, malignant hypertension, drugs and other predisposing factors.[ 15 , 28 ] In our cohort, two out of the five patients with TMA had a clinical diagnosis of TTP, although ADMAMTS13 tests were not available locally at the time of presentation. One patient confirmed to have APLS. Prompt identification of these entities is important, where specific managements such as therapeutic plasma exchange or eculizumab may be instituted.[ 15 ] It is well recognized that adult LN patients with TMA often have severe AKI [ 25 , 26 , 29 ], and had worse long-term renal prognosis.[ 10 , 26 , 29 ] Strufaldi et al. reported that patients with TMA had a significantly lower eGFR at biopsy and were more likely to develop kidney failure and mortality (82.9% vs 32.9%) [ 29 ] Li et al. also reported a lower 5-year kidney survival (70% vs 95%) in patients with LN and TMA.[ 26 ] In contrast, while 60% of our subjects with TMA necessitated acute dialysis support, their kidney function improved and none of them developed composite kidney outcome at last follow-up. AS was observed in 42% of RVL in our cohort but majority of them appeared concurrently with other forms of RVL. This suggests that AS may be a sequela following active inflammation of the blood vessels, rather than the primary pathological event. In our study, patients with RVLs had severe presentation with more severe kidney impairment and haematological manifestations when compared to the non-RVLs group. Our results also concurred with previous studies which demonstrated a significantly higher proportion of patients required acute dialysis support.[ 10 , 18 ] Importantly, both LN classification and activity index were not different between the two groups, and hence suggests the presence of RVLs on kidney biopsy portends more severe clinical manifestations. Our results showed that patients with RVL tended to have worse long-term renal outcome. The failure to reach statistical significance might be explained by small patient number in the RVL group. Another possible explanation is that more aggressive immunosuppressive therapy, such as cyclophosphamide, was offered to the RVL group, which led to similar disease remission rates in the short-term. Notwithstanding, the presence of NNV was an independent predictor of adverse kidney outcome according to our data. Lastly, whereas renal relapse occurs in 50% of patients in 10 years’ time[ 30 ], our data did not support a significant association between RVLs and the development of kidney relapse. Our study has a few limitations. First, due to limited patient number, we were unable to analyse each sub-type of RVLs individually. Around one-third of our cohort also had concurrent RVLs, which may confound the long-term outcomes. Second, excluding ICD in our cohort underestimate the prevalence of RVL in cLN though previous report see it as a hallmark of LN instead of a lesion by itself.[ 17 ] Third, while kidney biopsies were routinely performed at initial presentation, the indication for repeating biopsies remained controversial and were individualized according to disease severity. Fourth, managements of RVL were non-specific, and depended on both clinical severity and histological classifications, which might have confounded short- and long-term outcomes. Finally, the study is limited by its retrospective nature with potential referral and reporting bias. Nevertheless, our study has a relatively large patient number with long follow-up period and minimal missing data. In conclusion, RVLs is not uncommon and can occur in one-fifth of children and adolescents with LN. The presence of these lesions, particularly NNV, is associated with severe disease presentation and worse long-term kidney outcomes. Our data supports the incorporation of RVLs into the NIH activity and chronicity indices for better prediction of long-term outcomes. This may potentially help individualization of treatments to mitigate the need of acute dialysis and achieve satisfactory disease control.[ 31 ] Declarations The authors declare that they have no conflict of interest. References Huang JL, Yeh KW, Yao TC et al (2010) Pediatric lupus in Asia. Lupus 19:1414–1418. https://doi.org/10.1177/0961203310374339 Watson L, Leone V, Pilkington C et al (2012) Disease activity, severity, and damage in the UK Juvenile-Onset Systemic Lupus Erythematosus Cohort. Arthritis Rheum 64:2356–2365. https://doi.org/10.1002/art.34410 Sakamoto AP, Silva CA, Islabão AG et al (2022) Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus. https://doi.org/10.1007/s00467-022-05811-y . Pediatr Nephrol Berl Ger Oni L, Wright RD, Marks S et al (2021) Kidney outcomes for children with lupus nephritis. Pediatr Nephrol Berl Ger 36:1377–1385. https://doi.org/10.1007/s00467-020-04686-1 Chan EY-H, Lai FF-Y, Ma AL-T, Chan TM (2023) Managing Lupus Nephritis in Children and Adolescents. Paediatr Drugs. https://doi.org/10.1007/s40272-023-00609-3 Chan EY-H, Yap DY-H, Wong W-T et al (2023) Long-Term Outcomes of Children and Adolescents With Biopsy-Proven Childhood-Onset Lupus Nephritis. Kidney Int Rep 8:141–150. https://doi.org/10.1016/j.ekir.2022.10.014 Weening JJ, D’Agati VD, Schwartz MM et al (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 65:521–530. https://doi.org/10.1111/j.1523-1755.2004.00443.x Bajema IM, Wilhelmus S, Alpers CE et al (2018) Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int 93:789–796. https://doi.org/10.1016/j.kint.2017.11.023 Appel GB, Pirani CL, D’Agati V (1994) Renal vascular complications of systemic lupus erythematosus. J Am Soc Nephrol JASN 4:1499–1515. https://doi.org/10.1681/ASN.V481499 Wu L-H, Yu F, Tan Y et al (2013) Inclusion of renal vascular lesions in the 2003 ISN/RPS system for classifying lupus nephritis improves renal outcome predictions. Kidney Int 83:715–723. https://doi.org/10.1038/ki.2012.409 Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725. https://doi.org/10.1002/art.1780400928 Petri M, Orbai A-M, Alarcón GS et al (2012) Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 64:2677–2686. https://doi.org/10.1002/art.34473 Schwartz GJ, Muñoz A, Schneider MF et al (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol JASN 20:629–637. https://doi.org/10.1681/ASN.2008030287 Inker LA, Eneanya ND, Coresh J et al (2021) New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med 385:1737–1749. https://doi.org/10.1056/NEJMoa2102953 Rovin BH, Adler SG, Barratt J et al (2021) Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases. Kidney Int 100:753–779. https://doi.org/10.1016/j.kint.2021.05.015 Banfi G, Bertani T, Boeri V et al (1991) Renal vascular lesions as a marker of poor prognosis in patients with lupus nephritis. Gruppo Italiano per lo Studio della Nefrite Lupica (GISNEL). Am J Kidney Dis Off J Natl Kidney Found 18:240–248. https://doi.org/10.1016/s0272-6386(12)80885-7 Descombes E, Droz D, Drouet L et al (1997) Renal Vascular Lesions in Lupus Nephritis. Med (Baltim) 76:355–368. https://doi.org/10.1097/00005792-199709000-00003 Mejía-Vilet JM, Córdova-Sánchez BM, Uribe-Uribe NO et al (2017) Prognostic significance of renal vascular pathology in lupus nephritis. Lupus 26:1042–1050. https://doi.org/10.1177/0961203317692419 Barber C, Herzenberg A, Aghdassi E et al (2012) Evaluation of Clinical Outcomes and Renal Vascular Pathology among Patients with Lupus. Clin J Am Soc Nephrol 7:757–764. https://doi.org/10.2215/CJN.02870311 Huang J, Han S, Qin D et al (2015) Renal Interstitial Arteriosclerotic Lesions in Lupus Nephritis Patients: A Cohort Study from China. PLoS ONE 10:e0141547. https://doi.org/10.1371/journal.pone.0141547 Chu H, Wu L, Song D et al (2014) Noninflammatory necrotizing vasculopathy in lupus nephritis: a single-center experience. Lupus 23:20–30. https://doi.org/10.1177/0961203313512391 Gonzalez-Suarez M, Waheed A, Andrews D et al (2014) Lupus vasculopathy: Diagnostic, pathogenetic and therapeutic considerations. Lupus 23:421–427. https://doi.org/10.1177/0961203313520340 Sguigna PV, Tardo L, Conger D et al (2021) Asymptomatic retinal vasculopathy in neuropsychiatric systemic lupus erythematosus. J Neurol Sci 430:118053. https://doi.org/10.1016/j.jns.2021.118053 Chan AYK, Li EK, Wong GLH, Liu DTL (2006) Cerebellum vasculopathy and normal tension glaucoma in systemic lupus erythematosus: report of a case and review of the literature. Rheumatol Int 27:101–102. https://doi.org/10.1007/s00296-006-0161-0 Chen W, Liang S, Zuo K et al (2021) Clinicopathological features and outcomes of SLE patients with renal injury characterised by thrombotic microangiopathy. Clin Rheumatol 40:2735–2743. https://doi.org/10.1007/s10067-021-05627-5 Li C, Yap DYH, Chan G et al (2019) Clinical Outcomes and Clinico-pathological Correlations in Lupus Nephritis with Kidney Biopsy Showing Thrombotic Microangiopathy. J Rheumatol 46:1478–1484. https://doi.org/10.3899/jrheum.180773 Song D, Wu L, Wang F et al (2013) The spectrum of renal thrombotic microangiopathy in lupus nephritis. Arthritis Res Ther 15:R12. https://doi.org/10.1186/ar4142 Park MH, Caselman N, Ulmer S, Weitz IC (2018) Complement-mediated thrombotic microangiopathy associated with lupus nephritis. Blood Adv 2:2090–2094. https://doi.org/10.1182/bloodadvances.2018019596 Strufaldi FL, Menezes Neves PDM, de Dias M CB, et al (2021) Renal thrombotic microangiopathy associated to worse renal prognosis in Lupus Nephritis. J Nephrol 34:1147–1156. https://doi.org/10.1007/s40620-020-00938-3 Chan EY-H, Yap DY-H, Wong WH-S et al (2023) Renal relapse in children and adolescents with childhood-onset lupus nephritis: a 20-year study. Rheumatol Oxf Engl kead 447. https://doi.org/10.1093/rheumatology/kead447 Chan EY-H, Wong S-W, Lai FF-Y et al (2023) Long-term outcomes with rituximab as add-on therapy in severe childhood-onset lupus nephritis. Pediatr Nephrol Berl Ger 38:4001–4011. https://doi.org/10.1007/s00467-023-06025-6 Tables Table 1 – Baseline Demographics and laboratory findings at the time of LN diagnosis in patients with and without RVLs Clinical Characteristics All (n = 84) With renal vascular lesions (n = 19) Without renal vascular lesions (n = 65) P value Patients demographics Sex, Female 73 (86.9) 16 (84.2) 59 (87.7) NS Age at SLE diagnosis, y 12.9 ± 3.2 13.2 ± 3.4 12.9 ± 3.2 NS Age at LN diagnosis, y 14.0 [11.4, 16.5] 14.3 [11.7, 16.6] 14.0 [11.1, 16.4] NS Duration of follow-up 10.2 [5.7, 15.4] 11.3 [7.0, 15.5] 9.4 [4.5, 15.3] NS Laboratory variables at LN diagnosis Haemoglobin, g/dl 10.2 ± 1.7 9.4 ± 1.9 10.4 ± 1.6 0.045 Leukocyte, x 10 9 /l 4.6 [3.2, 6.3] 5.1 [3.9, 7.3] 4.5 [3.1, 6.2] NS Platelets, x 10 9 /l 184 [99, 270] 156 [88, 206] 188 [111.5, 286.5] NS Serum creatinine, µmol/l 55.5 [45.3, 78.8] 64 [55, 112] 54 [45, 76] 0.05 eGFR, ml/min/1.73m 2 95.5 ± 40.6 77.5 ± 42.9 100.8 ± 38.6 0.026 Spot urine Protein/Creatinine Ratio, mg/mg 2.5 [1.1, 5.5] 3.0 [1.6, 4.9] 2.4 [1.0, 5.5] NS Anti-dsDNA, IU/ml 232.6 ± 157.5 291.2 ± 249.8 220.7 ± 130.9 NS C3, g/L 0.37 [0.25, 0.48] 0.33 [0.23, 0.50] 0.37 [0.27, 0.48] NS SLEDAI score 17 [ 12 , 20 ] 16 [ 13 , 24 ] 17 [ 12 , 20 ] NS Additional antibodies profiles* Anti-Ro seropositivity 41 (51.3) 11 (64.7) 30 (47.6) NS Anti-LA seropositivity 7 (8.8) 1 (5.9) 6 (9.5) NS Anti-Sm seropositivity 18 (22.5) 6 (35.3) 12 (19.0) NS Anti-RNP seropositivity 23 (28.8) 6 (35.3) 17 (27.0) NS Anti-cardiolipin IgG/IgM seropositivity 22 (26.8) 5 (27.8) 17 (26.6) NS Lupus anticoagulant seropositivity 11 (13.3) 3 (16.7) 8 (12.3) NS Anti-nuclear cytoplasmic antibody (ANCA) 5 (7.5) 0 5 (9.6) NS Values are expressed as count (%), mean ± SD or median [IQR] NS = Not statistically significant, p value > 0.05 *With missing data Abbreviations : SLE, Systemic lupus erythematosus; LN, lupus nephritis; eGFR, estimated glomerular filtration rate; SLEDAI score, Systemic Lupus Erythematosus Disease Activity Index 2000; Anti-RNP, Anti-ribonuclear protein RNP Table 2 – Clinical characteristics among 107 biopsy episodes performed at initial presentation or kidney relapse Clinical Characteristics All (n = 107) Episodes with RVL (n = 19) Episodes without RVL (n = 88) P value Patients demographics Sex, Female 90 (84.1) 16 (84.2) 74 (84.1) NS Age of that episode, year 15.2 [12.1, 17.0] 15.9 [12.1, 17.4] 15.0 [12.1, 17.0] NS Episode NS Initial 83 (77.6) 14 (73.7) 68 (77.3) Relapse 24 (22.4) 5 (26.3) 20 (22.7) Clinical presentation NS Proteinuria 26 (24.3) 2 (10.5) 24 (27.3) Nephrotic syndrome 39 (36.4) 6 (31.6) 33 (37.5) Nephritic syndrome/ AKI requiring RRT 42 (39.3) 11 (57.9) 31 (35.2) Laboratory variables at episode presentation Haemoglobin, g/dl 10.2 ± 1.9 9.1 ± 1.9 10.4 ± 1.9 0.008 Leukocyte, x 10 9 /l 5 [3.8, 7.1] 5.2 [3.3, 7.2] 5 [3.8, 7.1] NS Platelets, x 10 9 /l 205.3 ± 106.1 150.1 ± 96.4 217.2 ± 104.8 0.012 Serum creatinine, µmol/l 60 [48, 95] 76 [55, 174] 57.0 [46, 79] 0.012 eGFR, ml/min/1.73m 2 90.5 ± 40.9 66.9 ± 40.3 95.6 ± 39.4 0.005 Spot urine Protein/Creatinine Ratio, mg/mg 3.1 [1.4, 6.2] 3.5 [1.7, 6.3] 2.9 [1.2, 6.0] NS Anti-dsDNA, IU/ml 209.5 ± 126.8 208.5 ± 132.8 209.6 ± 126.6 NS C3, g/L 0.38 [0.29, 0.52] 0.35 [0.27, 0.50] 0.39 [0.30, 0.53] NS SLEDAI score 16 [ 12 , 20 ] 16 [ 12 , 22 ] 15.5 [ 12 , 20 ] NS Values are expressed as count (%), mean ± SD or median [IQR] NS = Not statistically significant, p value > 0.05 Abbreviation: AKI, Acute kidney injury; RRT, Renal replacement therapy Table 3 – Histopathological features in biopsy-based episodes with and without RVLs Histopathology All (n = 107) Episodes with RVL (n = 19) Episodes without RVL (n = 88) P value ISN/RPS 2003 Class NS Class II 1 (0.9) 0 1 (1.1) Class III 22 (20.6) 6 (31.6) 19 (20.7) Class IV 43 (40.2) 7 (36.8) 36 (39.1) Class V 7 (6.5) 1 (5.3) 6 (6.5) Class III/IV + V 34 (31.8) 5 (26.3) 30 (32.6) Activity Index score 7.7 ± 4.2 8.6 ± 3.9 7.4 ± 4.2 NS Chronicity Index score 1.5 ± 2.0 1.5 ± 1.9 1.5 ± 2.0 NS Total score 9.2 ± 4.6 10.1 ± 4.5 9.0 ± 4.7 NS Values are expressed as count (%) or mean ± SD NS = Not statistically significant, p value > 0.05 Table 4 – Treatment regimen and treatment response in biopsy-based episodes with and without RVLs All (n = 107) Episodes with RVL (n = 19) Episodes without RVL (n = 88) P value Treatment Corticosteroid 107 (100) 19 (100) 88 (100) — IV Methylprednisolone 61 (57.0) 14 (73.7) 47 (53.4) NS Initial-maintenance therapy 0.002 CYC-MMF 24 (22.4) 10 (52.6) 14 (15.9) MMF-MMF 40 (37.4) 5 (26.3) 35 (39.8) CYC-AZA 13 (12.1) 1 (5.3) 12 (13.6) AZA-AZA 11 (10.3) 0 11 (12.5) Triple Therapy 10 (9.3) 1 (5.3) 9 (10.2) Others 9 (8.4) 2 (10.5) 7 (8.0) Adjunctive treatment Plasmapheresis 6 (5.6) 5 (26.3) 1 (1.1) < 0.001 Rituximab 10 (9.3) 3 (15.8) 7 (8.0) NS IVIg 2 (1.9) 2 (10.5) 0 0.03 Treatment response (KDIGO guideline) Response at 6 months NS Complete response 62 (57.9) 12 (63.2) 50 (56.8) Partial response 29 (27.1) 4 (21.1) 25 (28.4) No kidney response 16 (15.0) 3 (15.8) 13 (14.8) Response at 12 months NS Complete response 80 (74.8) 15 (78.9) 69 (73.9) Partial response 14 (13.1) 2 (10.5) 12 (13.6) No kidney response 13 (12.1) 2 (10.5) 11 (12.5) Values are expressed as count (%) NS = Not statistically significant, p value > 0.05 Abbreviations : AZA, Azathioprine; CNI, calcineurin inhibitors; CYC, cyclophosphamide; MMF, mycophenolate mofetil; IVIg, Intravenous immunoglobulin Triple therapy included use of CNI in addition to corticosteroid and MMF Other therapy included corticosteroid monotherapy, CYC-CYC, AZA-CNI, CNI-CNI Table 5 – Clinical outcomes of lupus nephritis with and without RVLs following treatment All (n = 84) Patients with RVL (n = 19) Patients without RVL (n = 65) p-value All RVL (n = 19) NNV (n = 11) Non-NNV RVL (n = 8) Relapses NS No Relapse 47 (56) 9 (47.4) 4 (36.4) 5 (62.5) 38 (58.5) One episode of relapse 23 (27.4) 7 (36.8) 5 (45.5) 2 (25) 16 (24.6) > 1 episode of relapse 14 (16.7) 3 (15.8) 2 (18.2) 1 (12.5) 11 (16.9) Development of CKD NS No CKD 71 (84.5) 14 (73.7) 7 (63.6) 7 (87.5) 57 (87.7) Stage 2 5 (6.0) 1 (5.3) 0 1 (12.5) 4 (6.2) Stage 3 1 (1.2) 0 0 0 1 (1.5) Stage 4 4 (4.8) 2 (10.5) 2 (18.2) 0 2 (3.1) Stage 5D 3 (3.6) 2 (10.5) 2 (18.2) 0 1 (1.5) Death 1 (1.2) 1 (5.3) 1 (9.1) 0 0 NS Renal parameters of last FU Serum creatinine µmol/L 56 [49, 72] 64 [55, 93] 102 [58, 220] 62.5 [55, 75] 55 [48, 64.5] 0.044 eGFR, ml/min per 1.73m2 109.8 ± 34.5 95.1 ± 44.7 79.6 ± 52.2 116.3 ± 18.6 114.1 ± 30.0 NS Urine protein-to-creatinine ratio, mg/mg 0.11 [0.07, 0.24] 0.11 [0.06, 0.3] 0.11 [0.06, 0.98] 0.09 [0.06, 0.12] 0.1 [0.07, 0.24] NS Values are expressed as count (%), mean ± SD or median [IQR] P value is calculated by comparing NNV, Non-NNV RVL and patients without RVL NS = Not statistically significant, p value > 0.05 Table 6 – Univariate analysis of risk factor for progression to composite outcome of advanced CKD (stage 3–5), ESKD and/or death Hazard ratio (95% CI) P value Age of SLE diagnosis, y 1.08 (0.84–1.38) NS Age of LN diagnosis, y 1.20 (0.93–1.55) NS Female* — — eGFR at time of diagnosis 0.99 (0.97–1.01) NS Acute dialysis at presentation 10.18 (1.70–61.10) 0.011 SLEDAI (≥ 12 points) 1.34 (0.16–10.89) NS Number of renal relapse 1.52 (0.87–2.63) NS Proliferative GN (III, IV, III/IV + V)* — — Activity index score in 1st biopsy 1.08 (0.87–1.33) NS Chronicity index score in 1st biopsy 1.76 (1.14–2.73) 0.011 Renal vascular lesions No renal vascular lesions 1 [ref.] — All RVL 3.45 (0.86–13.80) NS Non-inflammatory necrotizing vasculopathy (NNV) 7.08 (1.67–30.03) 0.005 RVL other than NNV* — — Remission status at/ before 12 months Complete/ Partial remission 1 [ref.] — Non-response 8.58 (2.00–36.86) 0.004 * Hazard ratio are degenerated because either all or no event are present in the group Cite Share Download PDF Status: Published Journal Publication published 09 Sep, 2024 Read the published version in Pediatric Nephrology → Version 1 posted Editorial decision: Major Revisions Needed 10 Apr, 2024 Reviewers agreed at journal 27 Feb, 2024 Reviewers invited by journal 26 Feb, 2024 Editor assigned by journal 26 Feb, 2024 First submitted to journal 24 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3988068","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":275307831,"identity":"dfe553a1-f315-4789-ac9c-f98fb8dd6450","order_by":0,"name":"Ying Kit 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Alison","middleName":"Lap-tak","lastName":"Ma","suffix":""}],"badges":[],"createdAt":"2024-02-25 13:17:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3988068/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3988068/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00467-024-06498-z","type":"published","date":"2024-09-09T15:57:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":52024758,"identity":"7732b768-f2a4-48d3-9bf6-b3301977d34f","added_by":"auto","created_at":"2024-03-05 15:45:44","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":760245,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow diagram, showing inclusion and exclusion of eligible cases for analysis\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3988068/v1/dc2232aee19b44765e134c69.jpeg"},{"id":52024757,"identity":"eab29d98-af7b-4a03-8f86-57c9bd2890b0","added_by":"auto","created_at":"2024-03-05 15:45:44","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":391426,"visible":true,"origin":"","legend":"\u003cp\u003eComposition of patients with biopsy-proven lupus nephritis in our cohort (n = 84)\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3988068/v1/c2738a5adbf456af84d7c305.jpg"},{"id":52024756,"identity":"b559c06c-a408-4246-a173-823a8396ac5c","added_by":"auto","created_at":"2024-03-05 15:45:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":75401,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier plot of the composite outcome including advanced chronic kidney disease (stage 3-5), ESKD and deaths in patients a) with and without RVLs; b) without RVLs, with Non-NNV RVLs and with NNV\u003c/p\u003e","description":"","filename":"F3.png","url":"https://assets-eu.researchsquare.com/files/rs-3988068/v1/63f16a489631467160241c3e.png"},{"id":64619511,"identity":"6fc35c4b-07f6-47bd-aacb-231b0ed4aee9","added_by":"auto","created_at":"2024-09-16 16:15:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2328496,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3988068/v1/db67410d-efd9-4b35-904e-a3671fe3378d.pdf"}],"financialInterests":"","formattedTitle":"Renal vascular lesions in Childhood-onset Lupus Nephritis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKidney involvement is common in childhood-onset systemic lupus erythematosus (cSLE), occurring in around 50\u0026ndash;80% of patients.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Around 4% of cSLE developed advanced chronic kidney disease (CKD).[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Up to 15% of patients with childhood-onset lupus nephritis (cLN) may progress to end-stage kidney disease (ESKD),[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and is also associated with significant morbidity and mortality, compared to general paediatric population.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHistopathological findings in LN are defined according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification. Prompt and accurate histological evaluation is important as it guides clinical management, since pathological findings are closely correlated to disease activity, treatment response and long-term renal outcomes.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Histopathological features in the ISN/RPS classification largely focus on glomerular and tubulointerstitial lesions, where renal vascular lesions (RVLs) are often overlooked. Renal vascular lesions (RVLs) in LN include arterial sclerosis (AS), non-inflammatory necrotizing vasculopathy (NNV), thrombotic microangiopathy (TMA), true renal vasculitis (TRV) and isolated immune complex deposits. Although the current ISN/RPS 2018 classification proposes standardized terminology and definition for RVLs, these findings have not been incorporated into the classification criteria.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] While these lesions have been reported to be associated with clinical severity and adverse kidney outcomes in adult-onset LN, their role as an independent prognostic factor remains controversial.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ecLN shows substantial differences in the disease pathogenesis, clinical presentation, epidemiology and outcomes compared to adult-onset LN.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] There is also no currently available data pertaining to the clinical significance of RVLs in cLN. In view of such knowledge gap, this study was set forth to investigate the prevalence, associated factors and long-term outcomes of RVLs in biopsy-proven cLN.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and patients\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study at the Paediatric Nephrology Centre of Hong Kong Children\u0026rsquo;s Hospital, Hong Kong, which was formerly located at Princess Margaret Hospital. The Paediatric Nephrology Centre is the designated referral centre for complicated childhood kidney disorders and paediatric kidney replacement therapy. All Chinese children with biopsy-proven cLN diagnosed before 18 years of age, between 1st January 2004 and 31st December 2020, were identified and included for analysis. The minimum follow-up period following initial therapy was 12 months and patients with alternative diagnoses, such as overlap syndrome, were excluded from the analysis. The diagnosis of SLE was based on 1997 American College of Rheumatology criteria and/or 2012 Systemic Lupus International Collaborating Clinics group classification criteria. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Data retrieval and analysis was approved by the Central Institution Review Board of the Hospital Authority, Hong Kong (Reference no. PAED-2022-002).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eRenal histopathology\u003c/h2\u003e \u003cp\u003eKidney biopsies were performed at the time of first renal presentation and in selected cases with severe kidney relapses. The kidney histology was either assessed or reviewed by the same experienced renal pathologist during the study period, and all biopsy samples were examined with light microscopy, immunofluorescence, and electron microscopy. Histology was classified according to the ISN/RPS 2003 classification.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFive types of RVL were carefully identified and reviewed[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]: 1) AS - thickening of arterial wall and narrowing of the lumen by intimal fibrosis and/or hyaline arteriosclerosis; 2) NNV - necrotizing changes in the vessel wall associate with abundant immune complex deposits, typically admixed with fibrin, without inflammation of the vessel wall, causing significant luminal narrowing or occlusion; 3) TMA - luminal narrowing or total occlusion by intraluminal, subendothelial or medial accumulation of eosinophilic, fuchsinophilic material with staining properties of fibrin, with the association of endothelial oedema and luminal thrombi; 4) TRV - prominent inflammatory cell infiltration of the arterial wall by neutrophils and mononuclear leukocytes; and 5) Isolated immune complex deposits (ICD) - Immunofluorescence study without corresponding changes on light microscopy. Isolated immune complex deposits, however, were difficult to evaluate due to retrospective assessment. Consequently, these patients with isolated immune complex deposits on immunofluorescence staining were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTherapy\u003c/h2\u003e \u003cp\u003eAll patients received standard immunosuppressive therapy for cLN (induction treatments during the first 3 to 6 months of therapy, followed by a maintenance phase). Induction therapies for patients with proliferative LN (Class III, IV and mixed III/IV\u0026thinsp;+\u0026thinsp;V) comprised of high-dose oral prednisolone (0.8-1mg/kg/day), with or without intravenous pulse methylprednisolone (10-30mg/kg per dose for 3 doses, max. 1 gram/dose). The other induction agent included mycophenolate mofetil (MMF, 1200mg/m\u003csup\u003e2\u003c/sup\u003e/day), or in severe cases with intravenous cyclophosphamide (CYC), based on National Institutes of Health (0.5-1g/m\u003csup\u003e2\u003c/sup\u003e monthly for 6 months) or Euro-Lupus regimens (500 mg every 2 weeks for 3 months). Patients with severe membranous LN (class V) were managed with a combination of oral prednisolone and MMF. The maintenance immunosuppression included low-dose prednisolone (3-5mg/day) with either azathioprine (AZA, 1.5-2mg/kg/day) or MMF (600-1200mg/m2/day). Triple immunosuppressive therapy with corticosteroids, MMF and calcineurin inhibitors, or adjunctive treatments such as rituximab was offered to selected patients who were refractory to first-line treatments. Anti-malaria and/or renin-angiotensin-aldosterone system inhibitors were prescribed unless contraindicated. There was no specific treatment for RVLs except therapeutic plasmapheresis in the presence of severe TMA.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eClinical evaluation\u003c/h2\u003e \u003cp\u003eData pertaining to patient demographics, clinical manifestations and laboratory results were obtained through electronic medical systems. Estimated glomerular filtration rate (eGFR) was calculated with serum creatinine, by revised Schwartz Formula for patients younger than 18 years[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and CKD-Epidemiology Collaboration (CKD-EPI) equation for 18 year-old patients.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Patients were followed every 1 to 8 weeks. Clinical parameters including blood pressure, urinalysis, physical examination findings were documented. Laboratory tests including complete blood count, renal biochemistry, anti-dsDNA, complement C3 levels and proteinuria were monitored regularly every 1 to 8 weeks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes\u003c/h2\u003e \u003cp\u003eThe primary outcome was a composite renal outcome of advanced CKD (stage 3\u0026ndash;5, eGFR\u0026thinsp;\u0026lt;\u0026thinsp;60ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e), ESKD requiring maintenance kidney replacement therapy (KRT) and/or mortality. Secondary outcomes included prevalence, clinical presentations, treatment response and association factors for RVLs. Complete remission (CR) was defined by KDIGO guidelines as sustained early morning urinary protein-creatinine ratio (UPCR)\u0026thinsp;\u0026lt;\u0026thinsp;0.5mg/mg.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Partial remission (PR) was defined as reduction in UPCR by \u0026gt;\u0026thinsp;=\u0026thinsp;50% and \u0026lt;\u0026thinsp;3mg/mg.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Both CR and PR required the stabilization or improvement in kidney function (\u0026plusmn;\u0026thinsp;10%~ 15% of baseline).[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed by IBM SPSS Statistics version 26 software. When comparing the demographics, laboratory variables, histological differences and treatment regimens, Fisher exact test or Pearson\u0026rsquo;s chi square test was used for categorical variables while student\u0026rsquo;s t-test, Mann-Whitney U test or Kruskal-Wallis Test was used for continuous variables. Survival curve and survival pattern for composite-renal outcomes was generated by Kaplan-Meier method. Log-rank test was used to evaluate the difference in survival probability from the composite-renal outcomes in different groups. Univariate model was constructed with hazard ratio on individual factors with COX regression analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eNinety-six patients with cLN were identified, of which 12 patients were excluded from the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A total of 84 patients were included in the final analysis with 107 kidney biopsies performed. The median follow-up time was 10.2 years (IQR 5.7, 15.4) from LN diagnosis. RVLs were observed in biopsies of 19 patients (22.6%). Fourteen kidney biopsies with RVLs were performed at LN diagnosis, while another five were done during kidney flares. Patients with or without RVLs on kidney biopsy showed no difference in gender, age of LN diagnosis, proteinuria, anti-dsDNA, C3, SLEDAI score, and the autoantibodies profile (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eHistological findings and clinical presentations\u003c/h2\u003e \u003cp\u003eAmong the 19 patients with RVLs on kidney biopsy, six (31.6%) had isolated NNV, four (21.1%) had TMA and three (15.8%) had AS. Six patients had concurrent RVLs. Four patients (21.1%) had concurrent NNV and arterial sclerosis while one (5.3%) had both NNV and TMA in the same biopsy. The remaining one patient (5.3%) had both TRV and AS (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The clinical presentations of LN episodes at the time of kidney biopsies are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. LN episodes with histological evidence of RVLs showed more severe renal manifestations, with higher serum creatinine (76 [Interquartile range IQR 55\u0026ndash;174] vs 57 [IQR 46\u0026ndash;79]\u0026micro;mol/l, p\u0026thinsp;=\u0026thinsp;0.012), lower eGFR (66.9\u0026plusmn;40.3 vs 95.6\u0026plusmn;39.4 ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e, p\u0026thinsp;=\u0026thinsp;0.005) and higher risk of nephritic syndrome or stage 3 acute kidney injury (AKI) necessitating acute dialysis (57.9% vs 35.2%, p\u0026thinsp;=\u0026thinsp;0.135). Haemoglobin (9.1\u0026plusmn;1.9 vs 10.4 \u0026plusmn;1.9 g/dL, p\u0026thinsp;=\u0026thinsp;0.008) and platelet levels (150.1 \u0026plusmn; 96.4 vs 217.2 \u0026plusmn; 104.8 x 10\u003csup\u003e9\u003c/sup\u003e/L, p\u0026thinsp;=\u0026thinsp;0.012) were also lower in LN episodes with RVLs. Of note, the histological classification, activity index and chronicity scores were similar between LN episodes with or without RVLs (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTherapy\u003c/h2\u003e \u003cp\u003eA significantly higher proportion of patients with RVLs received CYC-MMF as initial-maintenance therapy (52.6% vs 15.9%, p\u0026thinsp;=\u0026thinsp;0.002), and therapeutic plasmapheresis (26.3% vs 1.1%, p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to those without RVLs (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The main indication for plasma exchange is TMA. The use of rituximab was similar between the two groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eShort- and long-term kidney outcomes\u003c/h2\u003e \u003cp\u003eThe complete, partial, and non-remission rates at 6- and 12-months were comparable between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Patients with and without RVLs also had similar kidney relapse (RVL group 6.5 episodes per 100 patient-year vs non-RVL group 7.4 episodes per 100 patient-year, p value 0.69) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). At the last follow-up, the RVLs group had lower eGFR than the non-RVL group (95.1 \u0026plusmn; 44.7 vs 114.1 \u0026plusmn; 30.0 ml/min/1.73m\u003csup\u003e2,\u003c/sup\u003e p value 0.046). There was no significant difference between both groups for serum creatinine and UPCR. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Subgroup analysis further characterised RVLs into NNV and other forms of RVLs (non-NNV group). Patients with NNV, compared to non-NNV and non-RVL groups, had a significantly higher serum creatinine at last follow-up (102 [IQR 58\u0026ndash;220] vs 62.5 [IQR 55\u0026ndash;75] vs 55 [48, 64.5] \u0026micro;mol/l, p\u0026thinsp;=\u0026thinsp;0.044). NNV group also had a lower eGFR (79.6\u0026plusmn;52.2 vs 116.3\u0026plusmn;18.6 vs 114.1\u0026plusmn;30.0 ml/min/1.73m2, p\u0026thinsp;=\u0026thinsp;0.089) despite not reaching statistically significance. No clinical significance difference in proteinuria was observed in all three groups of patients.\u003c/p\u003e \u003cp\u003eThe RVL group was associated with an inferior survival free from composite renal outcomes, although it did not reach statistical significance (94.7% vs. 98.5%, 83.5% vs. 98.5%, 83.5% vs. 96.3% and 69.6% vs. 85.6% at 1-, 5, 10- and 15-years, respectively; p\u0026thinsp;=\u0026thinsp;0.062 by log-rank test) (Fig.\u0026nbsp;3a). The NNV group showed a significantly worse survival free from composite renal outcomes when comparing to the non-NNV and non-RVL groups (log-rank p\u0026thinsp;=\u0026thinsp;0.0018; Fig.\u0026nbsp;3b). The 1-, 5-, 10- and 15-year survival free from composite renal outcomes for NNV groups were 90.9%, 70.1%, 70.1% and 46.8%, respectively.\u003c/p\u003e \u003cp\u003eUnivariate analysis showed that the presence of NNV (HR 7.08, 95% CI 1.67\u0026ndash;30.03), alongside with acute dialysis at presentation (HR 10.18, 95% CI 1.70\u0026ndash;61.10), higher chronicity score at biopsy (HR 1.76, 95% CI 1.14\u0026ndash;2.73) and non-remission at 12-months after treatment (HR 8.58, 95% CI 2.00\u0026ndash;36.86) were associated with adverse kidney outcome. (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first cohort study that reported the clinical epidemiology and significance of RVLs in cLN. In our study, RVLs were observed in 22.6% patients with cLN. Importantly, the presence of RVLs, in particular, NNV, was associated with more severe clinical presentations and worse long-term kidney outcomes. This highlights the importance of including RVL as a part of the routine assessments on kidney histology in cLN.\u003c/p\u003e \u003cp\u003eOur results indicated that more than one-fifth of cLN patients showed RVLs on kidney biopsy. While cLN is often regarded as a more aggressive disease than adult-onset LN, the prevalence of RVLs in this study appeared to be lower than that in adults. This can be partly explained by the exclusion of ICD in our study. However, the prevalence of RVLs in adult-onset LN are highly variable (range between 28\u0026ndash;82%) and the types of RVLs reported were also rather heterogeneous.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] In our cohort, NNV and TMA were the most common RVLs on kidney biopsy in cLN. All currently available data on the types of RVLs in LN came from adult populations. While Wu et al. reported ICD represented 74.2% of RVLs, in other studies AS was observed in 24-57.8% of biopsies.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] The highly varying prevalence of RVLs could be a result of different classification definitions, patient populations, disease severity and duration, and evaluation methods.\u003c/p\u003e \u003cp\u003eNNV is distinguished from TRV by the absence of inflammatory cells in the blood vessel wall, and was the predominant RVL in our cohort, accounting for up to 57.9% of the RVLs. In adults, there is a considerable variation in its prevalence, ranging from 1.4 to 24%.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] RVL may exist as an isolated vascular lesion, though co-existing with other RVLs is not uncommon.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Its pathogenesis remains unclear. Nevertheless, with the presence of abundant immune complex deposits consisting of immunoglobulin and complements in the vessel walls, some postulate that immunologic factor plays the main role of the evolution of NNV. It is also commonly associated with diffuse proliferative LN.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] In addition, there may be extra-renal involvements such as cardiac, neurological, and retinal vasculopathy.[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Indeed, the presence of NNV on kidney biopsy is clinically important, as one-third of our patients with NNV reached the composite renal outcome. Although half of these patients had co-existing AS, we believe these were likely to be the sequelae of the endothelial damage in necrotizing vasculopathy. Our data demonstrated that NNV was associated with worse long-term renal outcome. In the adult population, there is conflicting evidence over the impact of NNV on long-term renal outcome. Banfi et al. reported a lower 5-year renal survival in patients with NNV (68.1 \u0026plusmn; 10.2% vs 89.6 \u0026plusmn; 2.7%), compared to those without.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] In contrast, Chu et al. and Mejia et al. did not observe such difference in kidney survival.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAnother important form of RVL is TMA, which accounted for 26.3% of the RVLs in our patients. In LN, its prevalence is reported to be between 0.5 to 24%.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] The causes of TMA in the setting of LN include anti-phospholipid syndrome (APLS), thrombotic thrombocytopenic purpura (TTP) and complement-mediated TMA. TMA could also be associated with infection, malignant hypertension, drugs and other predisposing factors.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] In our cohort, two out of the five patients with TMA had a clinical diagnosis of TTP, although ADMAMTS13 tests were not available locally at the time of presentation. One patient confirmed to have APLS. Prompt identification of these entities is important, where specific managements such as therapeutic plasma exchange or eculizumab may be instituted.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] It is well recognized that adult LN patients with TMA often have severe AKI [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and had worse long-term renal prognosis.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] Strufaldi et al. reported that patients with TMA had a significantly lower eGFR at biopsy and were more likely to develop kidney failure and mortality (82.9% vs 32.9%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] Li et al. also reported a lower 5-year kidney survival (70% vs 95%) in patients with LN and TMA.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] In contrast, while 60% of our subjects with TMA necessitated acute dialysis support, their kidney function improved and none of them developed composite kidney outcome at last follow-up. AS was observed in 42% of RVL in our cohort but majority of them appeared concurrently with other forms of RVL. This suggests that AS may be a sequela following active inflammation of the blood vessels, rather than the primary pathological event.\u003c/p\u003e \u003cp\u003eIn our study, patients with RVLs had severe presentation with more severe kidney impairment and haematological manifestations when compared to the non-RVLs group. Our results also concurred with previous studies which demonstrated a significantly higher proportion of patients required acute dialysis support.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Importantly, both LN classification and activity index were not different between the two groups, and hence suggests the presence of RVLs on kidney biopsy portends more severe clinical manifestations. Our results showed that patients with RVL tended to have worse long-term renal outcome. The failure to reach statistical significance might be explained by small patient number in the RVL group. Another possible explanation is that more aggressive immunosuppressive therapy, such as cyclophosphamide, was offered to the RVL group, which led to similar disease remission rates in the short-term. Notwithstanding, the presence of NNV was an independent predictor of adverse kidney outcome according to our data. Lastly, whereas renal relapse occurs in 50% of patients in 10 years\u0026rsquo; time[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], our data did not support a significant association between RVLs and the development of kidney relapse.\u003c/p\u003e \u003cp\u003eOur study has a few limitations. First, due to limited patient number, we were unable to analyse each sub-type of RVLs individually. Around one-third of our cohort also had concurrent RVLs, which may confound the long-term outcomes. Second, excluding ICD in our cohort underestimate the prevalence of RVL in cLN though previous report see it as a hallmark of LN instead of a lesion by itself.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Third, while kidney biopsies were routinely performed at initial presentation, the indication for repeating biopsies remained controversial and were individualized according to disease severity. Fourth, managements of RVL were non-specific, and depended on both clinical severity and histological classifications, which might have confounded short- and long-term outcomes. Finally, the study is limited by its retrospective nature with potential referral and reporting bias. Nevertheless, our study has a relatively large patient number with long follow-up period and minimal missing data.\u003c/p\u003e \u003cp\u003eIn conclusion, RVLs is not uncommon and can occur in one-fifth of children and adolescents with LN. The presence of these lesions, particularly NNV, is associated with severe disease presentation and worse long-term kidney outcomes. Our data supports the incorporation of RVLs into the NIH activity and chronicity indices for better prediction of long-term outcomes. This may potentially help individualization of treatments to mitigate the need of acute dialysis and achieve satisfactory disease control.[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHuang JL, Yeh KW, Yao TC et al (2010) Pediatric lupus in Asia. Lupus 19:1414\u0026ndash;1418. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0961203310374339\u003c/span\u003e\u003cspan address=\"10.1177/0961203310374339\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatson L, Leone V, Pilkington C et al (2012) Disease activity, severity, and damage in the UK Juvenile-Onset Systemic Lupus Erythematosus Cohort. Arthritis Rheum 64:2356\u0026ndash;2365. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/art.34410\u003c/span\u003e\u003cspan address=\"10.1002/art.34410\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSakamoto AP, Silva CA, Islab\u0026atilde;o AG et al (2022) Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00467-022-05811-y\u003c/span\u003e\u003cspan address=\"10.1007/s00467-022-05811-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Pediatr Nephrol Berl Ger\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOni L, Wright RD, Marks S et al (2021) Kidney outcomes for children with lupus nephritis. Pediatr Nephrol Berl Ger 36:1377\u0026ndash;1385. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00467-020-04686-1\u003c/span\u003e\u003cspan address=\"10.1007/s00467-020-04686-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan EY-H, Lai FF-Y, Ma AL-T, Chan TM (2023) Managing Lupus Nephritis in Children and Adolescents. Paediatr Drugs. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40272-023-00609-3\u003c/span\u003e\u003cspan address=\"10.1007/s40272-023-00609-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan EY-H, Yap DY-H, Wong W-T et al (2023) Long-Term Outcomes of Children and Adolescents With Biopsy-Proven Childhood-Onset Lupus Nephritis. Kidney Int Rep 8:141\u0026ndash;150. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ekir.2022.10.014\u003c/span\u003e\u003cspan address=\"10.1016/j.ekir.2022.10.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeening JJ, D\u0026rsquo;Agati VD, Schwartz MM et al (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 65:521\u0026ndash;530. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1523-1755.2004.00443.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1523-1755.2004.00443.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBajema IM, Wilhelmus S, Alpers CE et al (2018) Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney Int 93:789\u0026ndash;796. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.kint.2017.11.023\u003c/span\u003e\u003cspan address=\"10.1016/j.kint.2017.11.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAppel GB, Pirani CL, D\u0026rsquo;Agati V (1994) Renal vascular complications of systemic lupus erythematosus. J Am Soc Nephrol JASN 4:1499\u0026ndash;1515. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1681/ASN.V481499\u003c/span\u003e\u003cspan address=\"10.1681/ASN.V481499\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu L-H, Yu F, Tan Y et al (2013) Inclusion of renal vascular lesions in the 2003 ISN/RPS system for classifying lupus nephritis improves renal outcome predictions. Kidney Int 83:715\u0026ndash;723. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/ki.2012.409\u003c/span\u003e\u003cspan address=\"10.1038/ki.2012.409\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/art.1780400928\u003c/span\u003e\u003cspan address=\"10.1002/art.1780400928\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetri M, Orbai A-M, Alarc\u0026oacute;n GS et al (2012) Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 64:2677\u0026ndash;2686. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/art.34473\u003c/span\u003e\u003cspan address=\"10.1002/art.34473\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwartz GJ, Mu\u0026ntilde;oz A, Schneider MF et al (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol JASN 20:629\u0026ndash;637. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1681/ASN.2008030287\u003c/span\u003e\u003cspan address=\"10.1681/ASN.2008030287\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInker LA, Eneanya ND, Coresh J et al (2021) New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med 385:1737\u0026ndash;1749. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMoa2102953\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa2102953\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRovin BH, Adler SG, Barratt J et al (2021) Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases. Kidney Int 100:753\u0026ndash;779. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.kint.2021.05.015\u003c/span\u003e\u003cspan address=\"10.1016/j.kint.2021.05.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanfi G, Bertani T, Boeri V et al (1991) Renal vascular lesions as a marker of poor prognosis in patients with lupus nephritis. Gruppo Italiano per lo Studio della Nefrite Lupica (GISNEL). Am J Kidney Dis Off J Natl Kidney Found 18:240\u0026ndash;248. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s0272-6386(12)80885-7\u003c/span\u003e\u003cspan address=\"10.1016/s0272-6386(12)80885-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDescombes E, Droz D, Drouet L et al (1997) Renal Vascular Lesions in Lupus Nephritis. Med (Baltim) 76:355\u0026ndash;368. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00005792-199709000-00003\u003c/span\u003e\u003cspan address=\"10.1097/00005792-199709000-00003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMej\u0026iacute;a-Vilet JM, C\u0026oacute;rdova-S\u0026aacute;nchez BM, Uribe-Uribe NO et al (2017) Prognostic significance of renal vascular pathology in lupus nephritis. Lupus 26:1042\u0026ndash;1050. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0961203317692419\u003c/span\u003e\u003cspan address=\"10.1177/0961203317692419\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarber C, Herzenberg A, Aghdassi E et al (2012) Evaluation of Clinical Outcomes and Renal Vascular Pathology among Patients with Lupus. Clin J Am Soc Nephrol 7:757\u0026ndash;764. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2215/CJN.02870311\u003c/span\u003e\u003cspan address=\"10.2215/CJN.02870311\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang J, Han S, Qin D et al (2015) Renal Interstitial Arteriosclerotic Lesions in Lupus Nephritis Patients: A Cohort Study from China. PLoS ONE 10:e0141547. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0141547\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0141547\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChu H, Wu L, Song D et al (2014) Noninflammatory necrotizing vasculopathy in lupus nephritis: a single-center experience. Lupus 23:20\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0961203313512391\u003c/span\u003e\u003cspan address=\"10.1177/0961203313512391\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonzalez-Suarez M, Waheed A, Andrews D et al (2014) Lupus vasculopathy: Diagnostic, pathogenetic and therapeutic considerations. Lupus 23:421\u0026ndash;427. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0961203313520340\u003c/span\u003e\u003cspan address=\"10.1177/0961203313520340\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSguigna PV, Tardo L, Conger D et al (2021) Asymptomatic retinal vasculopathy in neuropsychiatric systemic lupus erythematosus. J Neurol Sci 430:118053. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jns.2021.118053\u003c/span\u003e\u003cspan address=\"10.1016/j.jns.2021.118053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan AYK, Li EK, Wong GLH, Liu DTL (2006) Cerebellum vasculopathy and normal tension glaucoma in systemic lupus erythematosus: report of a case and review of the literature. Rheumatol Int 27:101\u0026ndash;102. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00296-006-0161-0\u003c/span\u003e\u003cspan address=\"10.1007/s00296-006-0161-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen W, Liang S, Zuo K et al (2021) Clinicopathological features and outcomes of SLE patients with renal injury characterised by thrombotic microangiopathy. Clin Rheumatol 40:2735\u0026ndash;2743. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10067-021-05627-5\u003c/span\u003e\u003cspan address=\"10.1007/s10067-021-05627-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi C, Yap DYH, Chan G et al (2019) Clinical Outcomes and Clinico-pathological Correlations in Lupus Nephritis with Kidney Biopsy Showing Thrombotic Microangiopathy. J Rheumatol 46:1478\u0026ndash;1484. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3899/jrheum.180773\u003c/span\u003e\u003cspan address=\"10.3899/jrheum.180773\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong D, Wu L, Wang F et al (2013) The spectrum of renal thrombotic microangiopathy in lupus nephritis. Arthritis Res Ther 15:R12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/ar4142\u003c/span\u003e\u003cspan address=\"10.1186/ar4142\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark MH, Caselman N, Ulmer S, Weitz IC (2018) Complement-mediated thrombotic microangiopathy associated with lupus nephritis. Blood Adv 2:2090\u0026ndash;2094. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1182/bloodadvances.2018019596\u003c/span\u003e\u003cspan address=\"10.1182/bloodadvances.2018019596\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrufaldi FL, Menezes Neves PDM, de Dias M CB, et al (2021) Renal thrombotic microangiopathy associated to worse renal prognosis in Lupus Nephritis. J Nephrol 34:1147\u0026ndash;1156. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40620-020-00938-3\u003c/span\u003e\u003cspan address=\"10.1007/s40620-020-00938-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan EY-H, Yap DY-H, Wong WH-S et al (2023) Renal relapse in children and adolescents with childhood-onset lupus nephritis: a 20-year study. Rheumatol Oxf Engl kead 447. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/rheumatology/kead447\u003c/span\u003e\u003cspan address=\"10.1093/rheumatology/kead447\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan EY-H, Wong S-W, Lai FF-Y et al (2023) Long-term outcomes with rituximab as add-on therapy in severe childhood-onset lupus nephritis. Pediatr Nephrol Berl Ger 38:4001\u0026ndash;4011. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00467-023-06025-6\u003c/span\u003e\u003cspan address=\"10.1007/s00467-023-06025-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Baseline Demographics and laboratory findings at the time of LN diagnosis in patients with and without RVLs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eWith renal vascular lesions\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eWithout renal vascular lesions\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePatients demographics\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(86.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(87.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at SLE diagnosis, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at LN diagnosis, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e14.0 [11.4, 16.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14.3 [11.7, 16.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e14.0 [11.1, 16.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e10.2 [5.7, 15.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e11.3 [7.0, 15.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e9.4 [4.5, 15.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory variables at LN diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaemoglobin, g/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukocyte, x 10\u003csup\u003e9\u003c/sup\u003e/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.6 [3.2, 6.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5.1 [3.9, 7.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e4.5 [3.1, 6.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelets, x 10\u003csup\u003e9\u003c/sup\u003e/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e184 [99, 270]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e156 [88, 206]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e188 [111.5, 286.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum creatinine, \u0026micro;mol/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e55.5 [45.3, 78.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e64 [55, 112]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e54 [45, 76]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR, ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;40.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;42.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;38.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpot urine Protein/Creatinine Ratio, mg/mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.5 [1.1, 5.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.0 [1.6, 4.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2.4 [1.0, 5.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-dsDNA, IU/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e232.6\u0026thinsp;\u0026plusmn;\u0026thinsp;157.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e291.2\u0026thinsp;\u0026plusmn;\u0026thinsp;249.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e220.7\u0026thinsp;\u0026plusmn;\u0026thinsp;130.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC3, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.37 [0.25, 0.48]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.33 [0.23, 0.50]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.37 [0.27, 0.48]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSLEDAI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e17 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e16 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e17 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdditional antibodies profiles*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-Ro seropositivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(51.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-LA seropositivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-Sm seropositivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-RNP seropositivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-cardiolipin IgG/IgM seropositivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLupus anticoagulant seropositivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-nuclear cytoplasmic antibody (ANCA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eValues are expressed as count (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median [IQR]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eNS\u0026thinsp;=\u0026thinsp;Not statistically significant, p value\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*With missing data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eAbbreviations : SLE, Systemic lupus erythematosus; LN, lupus nephritis; eGFR, estimated glomerular filtration rate; SLEDAI score, Systemic Lupus Erythematosus Disease Activity Index 2000; Anti-RNP, Anti-ribonuclear protein RNP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Clinical characteristics among 107 biopsy episodes performed at initial presentation or kidney relapse\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eEpisodes with RVL\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eEpisodes without RVL\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePatients demographics\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(84.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(84.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of that episode, year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e15.2 [12.1, 17.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e15.9 [12.1, 17.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e15.0 [12.1, 17.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpisode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(77.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(77.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProteinuria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNephrotic syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNephritic syndrome/ AKI requiring RRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory variables at episode presentation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaemoglobin, g/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeukocyte, x 10\u003csup\u003e9\u003c/sup\u003e/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5 [3.8, 7.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5.2 [3.3, 7.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e5 [3.8, 7.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelets, x 10\u003csup\u003e9\u003c/sup\u003e/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e205.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;106.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;96.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e217.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;104.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum creatinine, \u0026micro;mol/l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e60 [48, 95]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e76 [55, 174]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e57.0 [46, 79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR, ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;40.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;40.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpot urine Protein/Creatinine Ratio, mg/mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.1 [1.4, 6.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.5 [1.7, 6.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2.9 [1.2, 6.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-dsDNA, IU/ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;126.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e208.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;132.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e209.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;126.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC3, g/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.38 [0.29, 0.52]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.35 [0.27, 0.50]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.39 [0.30, 0.53]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSLEDAI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e16 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e16 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e15.5 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eValues are expressed as count (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median [IQR]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eNS\u0026thinsp;=\u0026thinsp;Not statistically significant, p value\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003eAbbreviation: AKI, Acute kidney injury; RRT, Renal replacement therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Histopathological features in biopsy-based episodes with and without RVLs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistopathology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eEpisodes with RVL\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eEpisodes without RVL\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eISN/RPS 2003 Class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(40.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass III/IV\u0026thinsp;+\u0026thinsp;V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity Index score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronicity Index score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.5 \u0026plusmn; 2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.5 \u0026plusmn; 1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.5 \u0026plusmn; 2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eValues are expressed as count (%) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003cp\u003eNS\u0026thinsp;=\u0026thinsp;Not statistically significant, p value\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Treatment regimen and treatment response in biopsy-based episodes with and without RVLs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eEpisodes with RVL\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eEpisodes without RVL\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTreatment\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorticosteroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV Methylprednisolone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(57.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(53.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial-maintenance therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCYC-MMF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMF-MMF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCYC-AZA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAZA-AZA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriple Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdjunctive treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlasmapheresis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRituximab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVIg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment response (KDIGO guideline)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResponse at 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo kidney response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResponse at 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(74.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(78.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(73.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo kidney response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eValues are expressed as count (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eNS\u0026thinsp;=\u0026thinsp;Not statistically significant, p value\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eAbbreviations : AZA, Azathioprine; CNI, calcineurin inhibitors; CYC, cyclophosphamide; MMF, mycophenolate mofetil; IVIg, Intravenous immunoglobulin\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eTriple therapy included use of CNI in addition to corticosteroid and MMF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eOther therapy included corticosteroid monotherapy, CYC-CYC, AZA-CNI, CNI-CNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Clinical outcomes of lupus nephritis with and without RVLs following treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePatients with RVL\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePatients without RVL\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;65)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll RVL (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNNV (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-NNV RVL (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelapses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Relapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38 (58.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne episode of relapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 1 episode of relapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDevelopment of CKD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo CKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (84.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57 (87.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 5D\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDeath\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRenal parameters of last FU\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum creatinine \u0026micro;mol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 [49, 72]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 [55, 93]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102 [58, 220]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62.5 [55, 75]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55 [48, 64.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR, ml/min per 1.73m2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109.8\u0026thinsp;\u0026plusmn;\u0026thinsp;34.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.1\u0026thinsp;\u0026plusmn;\u0026thinsp;44.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.6\u0026thinsp;\u0026plusmn;\u0026thinsp;52.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e116.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e114.1\u0026thinsp;\u0026plusmn;\u0026thinsp;30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine protein-to-creatinine ratio, mg/mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.11 [0.07, 0.24]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11 [0.06, 0.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11 [0.06, 0.98]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.09 [0.06, 0.12]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1 [0.07, 0.24]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eValues are expressed as count (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median [IQR]\u003c/p\u003e \u003cp\u003eP value is calculated by comparing NNV, Non-NNV RVL and patients without RVL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNS\u0026thinsp;=\u0026thinsp;Not statistically significant, p value\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Univariate analysis of risk factor for progression to composite outcome of advanced CKD (stage 3\u0026ndash;5), ESKD and/or death\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHazard ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of SLE diagnosis, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08 (0.84\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of LN diagnosis, y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.20 (0.93\u0026ndash;1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR at time of diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.99 (0.97\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute dialysis at presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.18 (1.70\u0026ndash;61.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSLEDAI (\u0026ge;\u0026thinsp;12 points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.34 (0.16\u0026ndash;10.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of renal relapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.52 (0.87\u0026ndash;2.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProliferative GN (III, IV, III/IV\u0026thinsp;+\u0026thinsp;V)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity index score in 1st biopsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08 (0.87\u0026ndash;1.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronicity index score in 1st biopsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.76 (1.14\u0026ndash;2.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal vascular lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo renal vascular lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 [ref.]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll RVL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.45 (0.86\u0026ndash;13.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-inflammatory necrotizing vasculopathy (NNV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.08 (1.67\u0026ndash;30.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRVL other than NNV*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRemission status at/ before 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete/ Partial remission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 [ref.]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.58 (2.00\u0026ndash;36.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e* Hazard ratio are degenerated because either all or no event are present in the group\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Renal vascular lesions, childhood-onset lupus nephritis, SLE, systemic lupus erythematosus, non-inflammatory necrotizing vasculopathy, thrombotic microangiopathy","lastPublishedDoi":"10.21203/rs.3.rs-3988068/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3988068/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThis study aimed to determine the clinical significance of renal vascular lesions (RVLs) in childhood-onset lupus nephritis (cLN).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe retrospectively reviewed all children with biopsy-proven cLN between 2004-2020 to evaluate the prevalence of RVLs on kidney biopsy and its associated factors and long-term outcomes. The composite renal outcome was defined as advanced chronic kidney disease (CKD) stage 3-5, end-stage kidney disease (ESKD) and death.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003e107 biopsies from 84 Chinese patients were analysed. RVLs were observed in 19 patients (22.6%), including non-inflammatory necrotizing vasculopathy (NNV, n=6), thrombotic microangiopathy (TMA, n=4), arterial sclerosis (AS, n=3), concurrent NNV with AS (n=4), concurrent NNV with TMA (n=1) and concurrent true renal vasculitis with AS (n=1).\u003c/p\u003e\n\u003cp\u003eThe presence of RVLs was associated with lower estimated glomerular filtration rate (eGFR) (66.9±40.3 vs 95.6±39.4ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e, p=0.005), haemoglobin level (9.1±1.9 vs 10.4±1.9g/dL, p=0.008) and platelet count (150.1±96.4 vs 217.2±104.8 x 10\u003csup\u003e9\u003c/sup\u003e/L, p=0.01). LN classes and activity/chronicity indices were similar.\u003c/p\u003e\n\u003cp\u003ePatients with RVLs had poorer composite renal outcomes, though not reaching statistical significance (log-rank test, p=0.06). The presence of NNV was associated with inferior survival free from composite renal outcome (log-rank test, p = 0.0018), compared to other forms of RVLs and those without RVLs. Univariate analysis revealed NNV (HR 7.08, 95% CI 1.67-30.03) was predictive of composite renal outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eRVLs are present in one-fifth of cLN patients and are associated with severe presentation. NNV is associated with worse long-term renal outcome. Routine evaluation of RVLs is warranted and should be incorporated into future classification criteria.\u003c/p\u003e","manuscriptTitle":"Renal vascular lesions in Childhood-onset Lupus Nephritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-05 15:45:39","doi":"10.21203/rs.3.rs-3988068/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revisions Needed","date":"2024-04-10T11:31:30+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-02-27T08:36:26+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-02-27T04:36:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-26T19:06:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Nephrology","date":"2024-02-24T10:34:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3b8a0269-ea99-4a69-a055-ccafaa348622","owner":[],"postedDate":"March 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:08:06+00:00","versionOfRecord":{"articleIdentity":"rs-3988068","link":"https://doi.org/10.1007/s00467-024-06498-z","journal":{"identity":"pediatric-nephrology","isVorOnly":false,"title":"Pediatric Nephrology"},"publishedOn":"2024-09-09 15:57:25","publishedOnDateReadable":"September 9th, 2024"},"versionCreatedAt":"2024-03-05 15:45:39","video":"","vorDoi":"10.1007/s00467-024-06498-z","vorDoiUrl":"https://doi.org/10.1007/s00467-024-06498-z","workflowStages":[]},"version":"v1","identity":"rs-3988068","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3988068","identity":"rs-3988068","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}