The Decade Ahead: Predicting Long-Term Proteinuria Risk in SLE Save

The ACR Convergence 2025 in Chicago opens with engaging topics curated for the global rheumatologist. As a clinician, I always look forward to sessions that provide updates and practical key points that I can bring home and apply to my practice.

Lupus nephritis affects almost half of patients with SLE and conveys a mortality rate of up to 30% at 10 years; with at least 10-22% of patients developing end stage kidney disease. Early detection and diagnosis are key to provide appropriate management to patients and improve long-term outcomes.

Professor Michelle Petri presented Abstract 0837 on the “Risk of Proteinuria in Next Ten Years in SLE” during the afternoon abstract sessions of Oct. 26, 2025. Their group created a risk score for proteinuria that will help predict a patient’s risk of incident proteinuria within 10 years of SLE diagnosis. According to their model, the 10-year risk was estimated based on the number of risk factors that the patient has. Therefore, the more risk factors the patient has, the higher is their estimated 10-year risk. Major risk factors (scores as 2 each) included non-Caucasian race and the presence of anti-Smith. Meanwhile, moderate risk factors (scores as 1 each) were male sex, anti-RNP, anti-dsDNA, and low C4 at the time of diagnosis. A person with no risk factors has a 2.6% chance while a person with 8 risk factors has a 49% chance of developing proteinuria in 10 years.

How can this research data further help us in clinical decision making? What value does it add to what we already know about proteinuria risk in SLE? 

Some may even argue that the patient population and study duration may not be enough to generate a robust risk score. When taken into consideration together with the 2024 ACR Guidelines on Lupus Nephritis, it may give us a better sense of timing proteinuria screening and monitoring at more frequent intervals as well as considering renal biopsy early especially in the presence of major risk factors. In a resource-limited setting, I think it provides a practical approach in identifying lupus nephritis patients needing closer monitoring or follow-up.