Impact of baseline proteinuria level on long-term outcomes in lupus nephritis

IF 4.7 2区医学 Q1 RHEUMATOLOGY

Rheumatology Pub Date : 2024-10-24 DOI:10.1093/rheumatology/keae579

Fadi Kharouf, Qixuan Li, Laura P Whittall Garcia, Dafna D Gladman, Zahi Touma

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Abstract

Objectives Proteinuria is a marker of lupus nephritis (LN) activity and damage. We aimed to explore the impact of baseline proteinuria level on long-term outcomes. Methods We included 249 patients diagnosed with their first biopsy-proven LN. We divided patients based on baseline proteinuria into low-level (≤1 g/day, group 1; 62 patients), moderate-level (>1 and <3 g/day, group 2; 90 patients), and high-level proteinuria (≥3 g/day, group 3; 97 patients). Outcomes included complete proteinuria recovery (CPR) at 1 year, an adverse composite outcome (ESKD, a sustained ≥40% decline in eGFR, or death), and LN flares. Cox proportional hazard models were used to examine the association between baseline characteristics and long-term outcomes. Results At baseline, the median [IQR] age was 33.2 [26.4, 42.4] years; median proteinuria level was 2.2 [1.0, 3.8] g/day. 177 (71%) patients had proliferative lesions on biopsy; 59.7% in group 1, 78.9% in group 2, and 71.4% in group 3. The rate of achievement of CPR at 1 year was highest for group 1 and lowest for group 3. For long-term outcomes (median follow-up 8.4 years), the frequency of the adverse composite outcome was 27.4%, 26.7%, and 48.5% in groups 1, 2, and 3, respectively; p= 0.003. The corresponding frequency of flares was 27.4%, 38.2%, and 61.9%, respectively; p< 0.001. In the multivariable model for factors associated with long-term outcomes, there was no significant difference between groups 1 and 2; group 3 was associated with the worst prognosis. Conclusions Low-level proteinuria is commonly associated with proliferative LN and adverse long-term outcomes.

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基线蛋白尿水平对狼疮性肾炎长期疗效的影响

目的蛋白尿是狼疮肾炎（LN）活动和损害的标志。我们旨在探讨基线蛋白尿水平对长期预后的影响。方法我们纳入了 249 名首次经活检证实患有狼疮肾炎的患者。我们根据基线蛋白尿水平将患者分为低水平（≤1 克/天，第 1 组；62 例患者）、中水平（>1 和 <3 克/天，第 2 组；90 例患者）和高水平蛋白尿（≥3 克/天，第 3 组；97 例患者）。结果包括 1 年后蛋白尿完全恢复（CPR）、不良综合结果（ESKD、eGFR 持续下降≥40% 或死亡）和 LN 复发。Cox比例危险模型用于研究基线特征与长期结果之间的关系。结果基线时，中位[IQR]年龄为33.2 [26.4, 42.4]岁；中位蛋白尿水平为2.2 [1.0, 3.8]克/天。177名（71%）患者活组织检查发现有增殖性病变；第一组为59.7%，第二组为78.9%，第三组为71.4%。对于长期结果（中位随访 8.4 年），第 1 组、第 2 组和第 3 组出现不良综合结果的频率分别为 27.4%、26.7% 和 48.5%；P= 0.003。相应的复发频率分别为 27.4%、38.2% 和 61.9%；p< 0.001。在长期预后相关因素的多变量模型中，第 1 组和第 2 组之间没有显著差异；第 3 组的预后最差。结论低水平蛋白尿通常与增生性 LN 和不良的长期预后有关。

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

Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

7.30%

发文量

1091

审稿时长

2 months

期刊介绍： Rheumatology strives to support research and discovery by publishing the highest quality original scientific papers with a focus on basic, clinical and translational research. The journal’s subject areas cover a wide range of paediatric and adult rheumatological conditions from an international perspective. It is an official journal of the British Society for Rheumatology, published by Oxford University Press. Rheumatology publishes original articles, reviews, editorials, guidelines, concise reports, meta-analyses, original case reports, clinical vignettes, letters and matters arising from published material. The journal takes pride in serving the global rheumatology community, with a focus on high societal impact in the form of podcasts, videos and extended social media presence, and utilizing metrics such as Altmetric. Keep up to date by following the journal on Twitter @RheumJnl.