Portal de Periódicos da CAPES

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

2022; Oxford University Press; Volume: 61; Issue: 11 Linguagem: Inglês

10.1093/rheumatology/keac067

1462-0332

Philip M. Carlucci, Jessica Li, Andrea Fava, Kristina Deonaraine, David Wofsy, Judith A. James, Chaim Putterman, Betty Diamond, Anne Davidson, Derek M. Fine, Jose M. Monroy‐Trujillo, Mohamed G. Atta, Wade DeJager, Joel M. Guthridge, Kristin Haag, Deepak A. Rao, Michael B. Brenner, James A. Lederer, William Apruzzese, H. Michael Belmont, Peter Izmirly, Devyn Zaminski, Ming Wu, Sean Connery, Fernanda Payan‐Schober, Richard Furie, Maria Dall’Era, Kerry Cho, Diane L. Kamen, Kenneth Kalunian, Jennifer H. Anolik, Jennifer L. Barnas, Mariko Ishimori, Michael H. Weisman, J. Le Goff, Patrick Dunn, Soumya Raychaudhuri, Fan Zhang, Ilya Korsunsky, Aparna Nathan, Joseph Mears, Kazuyoshi Ishigaki, Qian Xiao, Nghia Millard, Kathryn Weinand, Saori Sakaue, Paul J. Utz, Rong Mao, Bill Robinson, Holden T. Maecker, Susan Macwana, S. Louis Bridges, Vivian P. Bykerk, Laura T. Donlin, Susan M. Goodman, Edward F. DiCarlo, Melanie Smith, Amit Lakhanpal, Heather L. Sherman, Anvita Singaraju, Lorien Shakib, Christopher T. Ritchlin, Brendan F. Boyce, Darren Tabechian, Andrew McDavid, Javier Rangel‐Moreno, Nida Meednu, Jen Albrecht, Kevin Wei, A. Helena Jonsson, Daimon P. Simmons, Gregory Keras, Joshua Keegan, Gerald F. Watts, Yuhong Li Zhu, Adam Chicoine, Zhihan Jian Li, Ellen M. Gravallese, Kaitlyn Howard, Mandy J. McGeachy, Gary S. Firestein, David L. Boyle, Arnold Ceponis, Peter K. Gregersen, Diane Horowitz, Harris Perlman, Salina Dominguez, Carla M. Cuda, Arthur M Mandolin, Anjali Thakrar, Joan M. Bathon, Laura Hughes, V. Michael Holers, Jennifer Seifert, Kevin D. Deane, Larry W. Moreland, Andrew Filer, Karim Raza, Ilfita Sahbudin, Costantino Pitzalis, Myles Lewis, Felice Rivellese, Alessandra Nerviani, Stefano Bombardieri, Lindsy Forbess, Ami Ben‐Artzi, Karen Salomon-Escoto, Arnon Arazi, Raymond K. Hsu, Robert M. Clancy, Béatrice Goilav, David A. Hildeman, E. Steve Woodle, Nir Hacohen, Paul Hoover, Thomas Eisenhaure, Michael A. Peters, Tony Jones, David Lieb, Thomas Tuschl, Hemant Suryawanshi, Pavel Morozov, Manjunath Kustagi, Maureen McMahon, Jennifer Grossman, Matthias Kretzler, Céline C. Berthier, Jeffrey B. Hodgin, Raji Menon, Jill P. Buyon, Michelle Petri,

Chronic Kidney Disease and Diabetes

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.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.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.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.