Relationship between hypoalbuminemia, hyperlipidemia and renal severity in patients with lupus nephritis: a prospective study

Abstract

Aim of the study: The purpose is to evaluate the relationship between hypoalbuminemia, hyperlipidemia, nephrotic and renal severity in patients with lupus nephritis.

Material and methods: Autoantibodies and serological parameters were measured and analyzed in 429 patients with lupus nephritis in a single centre.

Results: The prevalence for anti-dsDNA, anti-nucleosome and anti-histone was higher in the nephrotic syndrome (NS) patients than that in non-NS patients (p < 0.0001 for all comparisons). The NS patients had a higher proportion of diffuse proliferative renal lesions (69.05%) and membranous lesions (68.00%). Serum total cholesterol and albumin levels were associated with activity and severity of renal disease. The levels of proteinuria and serum albumin were positively correlated with activity and chronicity index (p < 0.001 for all correlations). The incidence of a poor renal outcome (p = 0.0461) in the NS patients was significantly increased. On the other hand, the remission rate (p = 0.0002) was significantly reduced and recurrence rate (p = 0.0027) was significantly increased in NS patients.

Conclusions: This paper highlights that nephrotic-range proteinuria, elevated total cholesterol level and decreased serum albumin levels may reflect the activity and severity of renal damage in SLE patients.

Keywords: activity; hyperlipidemia; hypoalbuminemia; renal damage; systemic lupus erythematosus.

Fig. 1

A) Prevalence of NS in patients with diffuse proliferative renal lesions (class IV) and membranous lesions (class V) versus non-diffuse proliferative lesions (class I + II + III) (p = 0.0005, p = 0.0023, respectively); B) Prevalence of CHOL ≥ 5.7 in patients with diffuse proliferative renal lesions (class IV) versus non-diffuse proliferative lesions (class I + II + III) and membranous lesions (class V) (p = 0.0085, p = 0.3035, respectively). C) Prevalence of ALB ≤ 20 in patients with membranous lesions (class V) versus non-diffuse proliferative lesions (class I + II + III) and diffuse proliferative renal lesions (class IV) (p = 0.0003, P = 0.0348, respectively)

Fig. 2

Correlation between proteinuria / serum albumin level / and activity index (AI) / chronicity index (CI) in patients with lupus nephritis. A) Correlation between proteinuria and AI (r = 0.3495, p < 0.0001); B) Correlation between serum albumin level and CI (r = 0.3586, p < 0.0001); C) Correlation between serum albumin level and AI (r = –0.3719, p < 0.0001); D) Correlation between serum albumin level and CI (r = –0.3005, p = 0.0002)