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. 2022 Nov 2;61(11):4335-4343.
doi: 10.1093/rheumatology/keac067.

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

Philip M Carlucci  1 , Jessica Li  2 , Andrea Fava  2 , Kristina K Deonaraine  1 , David Wofsy  3 , Judith A James  4 , Chaim Putterman  5   6 , Betty Diamond  7 , Anne Davidson  7 , Derek M Fine  8 , Jose Monroy-Trujillo  8 , Mohamed G Atta  8 , Wade DeJager  4 , Joel M Guthridge  4 , Kristin Haag  2 , Deepak A Rao  9 , Michael B Brenner  9 , James A Lederer  9 , William Apruzzese  9 , H Michael Belmont  1 , Peter M Izmirly  1 , Devyn Zaminski  1 , Ming Wu  1 , Sean Connery  10 , Fernanda Payan-Schober  10 , Richard Furie  11 , Maria Dall'Era  3 , Kerry Cho  12 , Diane Kamen  13 , Kenneth Kalunian  14 , Jennifer Anolik  15 , Jennifer Barnas  15 , Mariko Ishimori  16 , Michael H Weisman  16 ; Accelerating Medicines Partnership (AMP) RA/SLE Network; Jill P Buyon  1 , Michelle Petri  2
Collaborators, Affiliations

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

Philip M Carlucci et al. Rheumatology (Oxford). .

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.

Keywords: diagnosis; lupus nephritis; systemic lupus erythematosus.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Change in UPCR over 1 year for patients with baseline UPCR <1 (A) UPCR at baseline (n = 8), 6 months (n = 5) and 1 year (n = 7) for patients with baseline UPCR <1 and class II renal histology. (B) UPCR at baseline (n = 29), 6 months (n = 28) and 1 year (n = 29) for patients with baseline UPCR <1 and class III, IV, V or mixed renal histology. UPCR: urine protein:creatinine ratio.
See this image and copyright information in PMC

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