Specific in situ inflammatory states associate with progression to renal failure in lupus nephritis.

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Abstract

In human lupus nephritis (LN), tubulointerstitial inflammation (TII) on biopsy predicts progression to end-stage renal disease (ESRD). However, only about half of patients with moderate/severe TII develop ESRD. We hypothesized that this heterogeneity in outcome reflects different underlying inflammatory states. Therefore, we interrogated renal biopsies from LN longitudinal and cross-sectional cohorts.Data was acquired using conventional and highly multiplexed confocal microscopy. To accurately segment cells across whole biopsies, and to understand their spatial relationships, we developed computational pipelines by training and implementing several deep learning models and other computer vision techniques.High B cell densities were associated with protection from ESRD. In contrast, CD8, γδ and other CD4-CD8- T cells, were associated with both acute renal failure and progression to ESRD. B cells were often organized into large periglomerular neighborhoods with T follicular helper cells while CD4- T cells formed small neighborhoods in the tubulointerstitium whose frequency predicted progression to ESRD.These data reveal that specific in situ inflammatory states are associated with refractory and progressive renal disease.These studies were funded by the NIH Autoimmunity Centers of Excellence (AI082724), Department of Defense (LRI180083) and Alliance for Lupus Research, NIH S10-OD025081, S10-RR021039, and P30-CA14599 awards.