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Kidney Week

Abstract: FR-PO881

Lupus Patients with Low-Level Proteinuria: Time to Revisit the Guidelines

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Chedid, Alice, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Fine, Derek M., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Rosenberg, Avi Z., Johns Hopkins University , Baltimore, Maryland, United States
  • Rossi, Giovanni maria, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Menez, Steven, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Arend, Lois J., Johns Hopkins Hospital, Baltimore, Maryland, United States
Background

Kidney biopsy is an important diagnostic tool in lupus nephritis. ACR guidelines recommend biopsy for proteinuria (>1000 mg), or proteinuria (≥500 mg) with hematuria,cellular casts or high creatinine. The presence of low level proteinuria (<1000 mg) alone doesn't qualify for a kidney biopsy.

Methods

We evaluated 150 SLE patients with low level proteinuria who underwent kidney biopsies between June 2003 to September 2018. 84 patients had only low level proteinuria.18 patients had low level proteinuria & hematuria. 48 patients had low level proteinuria & AKI

Results

Patients only with low level proteinuria: 67 of 84 patients (79.7%) had LN on kidney biopsy. 21 (25%) had proliferative LN; 16 (19%) had class III and 5 (6%) had class IV. 11(13.2%) had mixed classes (III or IV & V).17(20.2%) had LN class V. The remaining 17 (20.3%) had non-lupus diagnosis.When hematuria was present,17 of 18 (94.4%) had LN: 9 (50%) had proliferative LN; 5 (27.8%) had class III & 4 (22.2%) had class IV. 3 (16.6%) had mixed classes. 4 (22.2%) had LN class V. Only one patient (5.6%) had non-lupus diagnosis. Adding AKI to low level proteinuria: 37 of 48 (77.1%) had LN on kidney biopsy. 11 (22.9%) had proliferative LN, 6(12.5%) had LN class III and 5 (10.4%) had LN class IV. 7(14.6%) had mixed classes. 8 (16.7%) had LN class V. The remaining 11(22.9%) had non-lupus diagnoses. Patients with AKI & low level proteinuria had a higher chronicity index (p-value 0.002) compared to patients with low level proteinuria alone.

Conclusion

SLE patients with low level proteinuria frequently have significant renal involvement on kidney biopsy including class III, IV, V and mixed class. This study, contrary to ACR guidelines, supports performance of kidney biopsy in those with isolated low level proteinuria