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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
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Low-Level Proteinuria in Systemic Lupus Erythematosus
Alice Chedid1,2, Giovanni M Rossi3,4,5, Francesco Peyronel3,4
1Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Kidney International Reports
|December 11, 2020
Summary
Systemic lupus erythematosus (SLE) patients with low-level proteinuria often have significant kidney disease. Kidney biopsies should be considered for isolated proteinuria, as current guidelines may miss important diagnoses.
Area of Science:
- Nephrology
- Rheumatology
- Internal Medicine
Background:
- Current guidelines for lupus nephritis (LN) diagnosis in systemic lupus erythematosus (SLE) rely on specific proteinuria thresholds (500-1000 mg/24h) or active urinary findings.
- Evaluating the diagnostic yield of kidney biopsy in SLE patients with proteinuria below these established cutoffs is crucial for refining clinical practice.
Purpose of the Study:
- To investigate the histopathological findings in SLE patients with proteinuria levels below 1000 mg/24-hour.
- To assess the relevance of current proteinuria cutoffs in guiding kidney biopsy decisions for SLE patients.
Main Methods:
- Retrospective review of clinical, laboratory, and histological data from SLE patients who underwent their first kidney biopsy.
- Analysis focused on patients with proteinuria <1000 mg/24-hour or <1000 mg/g UPCR between 2003 and 2018.
Main Results:
- Of 87 SLE patients with proteinuria <1000 mg/24h, 52 (60%) had isolated proteinuria without AKI or active sediment.
- Histologic evidence of lupus nephritis (LN) was found in 40 of these 52 patients (76%), including severe forms (Class III/IV).
- Non-lupus kidney diseases were also identified; LN presence was not reliably predicted by standard laboratory markers.
Conclusions:
- SLE patients with low-level proteinuria may harbor significant lupus- or non-lupus-related kidney disease.
- The high prevalence of significant LN, including severe forms, suggests current proteinuria thresholds for kidney biopsy may be too high.
- Revised guidelines should consider including isolated proteinuria of any level for kidney biopsy indication in SLE patients.
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