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- Title
High incidence of proliferative and membranous nephritis in SLE patients with low proteinuria in the Accelerating Medicines Partnership.
- Authors
Carlucci, Philip M; Li, Jessica; Fava, Andrea; Deonaraine, Kristina K; Wofsy, David; James, Judith A; Putterman, Chaim; Diamond, Betty; Davidson, Anne; Fine, Derek M; Monroy-Trujillo, Jose; Atta, Mohamed G; DeJager, Wade; Guthridge, Joel M; Haag, Kristin; Rao, Deepak A; Brenner, Michael B; Lederer, James A; Apruzzese, William; Belmont, H Michael
- Abstract
Objective Delayed detection of LN associates with worse outcomes. There are conflicting recommendations regarding a threshold level of proteinuria at which biopsy will likely yield actionable management. This study addressed the association of urine protein:creatinine ratios (UPCR) with clinical characteristics and investigated the incidence of proliferative and membranous histology in patients with a UPCR between 0.5 and 1. Methods A total of 275 SLE patients (113 first biopsy, 162 repeat) were enrolled in the multicentre multi-ethnic/racial Accelerating Medicines Partnership across 15 US sites at the time of a clinically indicated renal biopsy. Patients were followed for 1 year. Results At biopsy, 54 patients had UPCR <1 and 221 had UPCR ≥1. Independent of UPCR or biopsy number, a majority (92%) of patients had class III, IV, V or mixed histology. Moreover, patients with UPCR <1 and class III, IV, V, or mixed had a median activity index of 4.5 and chronicity index of 3, yet 39% of these patients had an inactive sediment. Neither anti-dsDNA nor low complement distinguished class I or II from III, IV, V or mixed in patients with UPCR <1. Of 29 patients with baseline UPCR <1 and class III, IV, V or mixed, 23 (79%) had a UPCR <0.5 at 1 year. Conclusion In this prospective study, three-quarters of patients with UPCR <1 had histology showing class III, IV, V or mixed with accompanying activity and chronicity despite an inactive sediment or normal serologies. These data support renal biopsy at thresholds lower than a UPCR of 1.
- Subjects
LUPUS nephritis; BIOPSY; DISEASE incidence; HEALTH outcome assessment; T-test (Statistics); PEARSON correlation (Statistics); PROTEINURIA; CHI-squared test; DESCRIPTIVE statistics; SYSTEMIC lupus erythematosus; ETHNIC groups; HISTOLOGY; LONGITUDINAL method; CREATININE
- Publication
Rheumatology, 2022, Vol 61, Issue 11, p4335
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/keac067