Predicting CKD Outcomes in Lupus Nephritis Save

An observational cohort study suggests that proteinuria levels in lupus nephritis (LN) patients did not predict their histologic class.

A multicentre observational study of patients with biopsy-proven LN; either proliferative (PLN) or membranous (MLN) lupus nephritis were compared regarding clinical and laboratory presentation and long-term outcomes. The primary outcome was progression to chronic kidney disease (CKD).

A total of 260 LN patients were included, with a median follow-up of 8 years. 

MLN patients had significantly lower serum creatinine (0.70 mg/dl vs 0.80, p= 0.003) than PLN at presentation.. 

Overall, proteinuria levels did not differ between groups (p= 0.641).  Moreover, proteinuria at diagnosis or at one year did not predict long term CKD progression. Nonetheless, lower proteinuria at diagnosis was more likely to achieve a complete renal response at one year. 

Levels of complement were reduced in PLN but nearly normal in MLN patients, and there were fewer patients with positive anti-dsDNA antibodies in the MLN group (p< 0.001). 

Estimated glomerular filtration rate (eGFR) ≤75 mL/min/1.73 m² at one year was the strongest predictor of progression to CKD (HR 23 [95% CI 8–62], p< 0.001). 

Other predictors of CKD included the use of azathioprine , older age at diagnosis and male sex.