Details

Autor(en) / Beteiligte

• 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
• Izmirly, Peter M
• Zaminski, Devyn
• Wu, Ming
• Connery, Sean
• Payan-Schober, Fernanda
• Furie, Richard
• Dall'Era, Maria
• Cho, Kerry
• Kamen, Diane
• Kalunian, Kenneth
• Anolik, Jennifer
• Barnas, Jennifer
• Ishimori, Mariko
• Weisman, Michael H
• Buyon, Jill P
• Petri, Michelle

Titel

High incidence of proliferative and membranous nephritis in SLE patients with low proteinuria in the Accelerating Medicines Partnership

Ist Teil von

• Rheumatology (Oxford, England), 2022-11, Vol.61 (11), p.4335-4343

Ort / Verlag

England: Oxford University Press

Erscheinungsjahr

2022

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• 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. 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. 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. 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.