Does the standard proteinuria cut-off for renal biopsy in lupus nephritis as per the current guidelines hold good for Asian population? A single-centre study from South India.

IF 1.9 4区 医学 Q3 RHEUMATOLOGY
Lupus Pub Date : 2024-11-01 Epub Date: 2024-10-03 DOI:10.1177/09612033241289806
Shivraj Padiyar, Chandu As, Mahasampath Gowri, John Mathew
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引用次数: 0

Abstract

Introduction: Current rheumatology and nephrology society guidelines in lupus nephritis do not recommend renal biopsy for proteinuria of less than 500 mg/24 h. This might lead to a significant delay in the early diagnosis of lupus nephritis.

Aim: The main aim of this study is to determine the nature of renal lesions in patients with low-grade proteinuria and to analyze the predictors for clinically significant lupus nephritis.

Methods: This was a single-center, retrospective study. All consecutive patients of lupus nephritis, with low-grade proteinuria (200 mg to 500 mg/24 h) undergoing renal biopsy were enrolled in this study. The renal biopsies were classified into significant lesions (Class III/IV/V) and non-significant lesions (Class I and II). Treatment naïve groups and treatment-modified groups were analyzed separately. Predictive factors for significant renal lesions were determined by univariate and multivariate analysis.

Results: We identified 183 patients of lupus with proteinuria between 200 and 500 mg / 24 h. Mean (SD) age was 30.2 (11.39) years with 167 (91.2%) of them being females. The mean (SD) baseline proteinuria was 351.03 (98.1) mg/24 h 85 patients (46.5%) had proliferative lupus nephritis where whereas 17 patients (9.3%) had membranous nephropathy. Crescents and fibrinoid necrosis were seen in 10 (5.46%) and 24 (13.11 %) patients respectively. Isolated proteinuria without any other sediments was seen in 95 patients (51.9%) of which 29 patients had proliferative lupus nephritis. Elevated Anti-double stranded DNA (anti-dsDNA), low C3, low C4 and the presence of urinary sediments were significantly associated with significant renal lesions in biopsy.

Conclusion: Significant renal lesions were seen in around half of the patients with low-grade proteinuria underscoring the importance of performing a renal biopsy in this set of patients. Low C3 and C4, urinary sediments, and elevated anti-dsDNA were predictors for significant renal lesions.

现行指南规定的狼疮性肾炎肾活检蛋白尿标准临界值是否适用于亚洲人群?一项来自南印度的单中心研究。
导言:目的:本研究的主要目的是确定低水平蛋白尿患者肾脏病变的性质,并分析具有临床意义的狼疮性肾炎的预测因素:这是一项单中心回顾性研究。方法:这是一项单中心回顾性研究,所有连续接受肾活检的狼疮肾炎患者均伴有低水平蛋白尿(200 毫克至 500 毫克/24 小时)。肾活检分为重要病变(III/IV/V 级)和非重要病变(I 级和 II 级)。分别分析了未接受治疗组和接受过治疗组。通过单变量和多变量分析确定了肾脏重大病变的预测因素:平均(标清)年龄为 30.2(11.39)岁,其中 167 人(91.2%)为女性。平均(标清)基线蛋白尿为 351.03 (98.1) 毫克/24 小时。85 名患者(46.5%)患有增生性狼疮肾炎,17 名患者(9.3%)患有膜性肾病。分别有 10 例(5.46%)和 24 例(13.11%)患者出现新月体和纤维素性坏死。95名患者(51.9%)出现孤立性蛋白尿,无任何其他沉淀物,其中29名患者患有增生性狼疮肾炎。抗双链 DNA(anti-dsDNA)升高、低 C3、低 C4 和尿沉渣的存在与活组织检查中肾脏的明显病变有显著相关性:结论:约半数低蛋白尿患者的肾脏有明显病变,这说明对这类患者进行肾活检的重要性。低C3和C4、尿沉淀物和抗dsDNA升高是肾脏重大病变的预测因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
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