Albuminuria in Lupus Nephritis: the hidden threat to cardiovascular health
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Updated: Apr 7, 2026
Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
Julio Francisco Colina-García1, Irene Martin Capón1, María Galindo2,3,4
1Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Insights
Pathological albuminuria is common in lupus nephritis patients achieving Complete Renal Response. Persistent albuminuria indicates a need for monitoring and optimized treatment due to risks of adverse renal and cardiovascular outcomes.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- Systemic lupus erythematosus (SLE) frequently causes kidney damage, specifically lupus nephritis (LN).
- Current Complete Renal Response (CRR) criteria for LN primarily focus on proteinuria, potentially overlooking albuminuria.
- Albuminuria is a known risk factor for adverse renal and cardiovascular outcomes in glomerular diseases.
Purpose of the Study:
- To determine the prevalence of pathological albuminuria in LN patients meeting CRR criteria.
- To investigate if residual albuminuria predicts different clinical outcomes in these patients.
Main Methods:
- An ambispective, observational study of 91 lupus nephritis patients.
- Pathological albuminuria defined as urinary albumin-creatinine ratio > 30 mg/g.
- Comparison of outcomes between patients with and without pathological albuminuria despite achieving CRR.
Main Results:
- 80.5% of CRR patients exhibited pathological albuminuria at remission; 55.8% had it at follow-up.
- Patients with pathological albuminuria had higher proteinuria at onset and remission.
- Persistent albuminuria correlated with more intensive antiproteinuric treatment, leading to reduced proteinuria and albuminuria.
Conclusions:
- Pathological albuminuria is prevalent even in LN patients achieving CRR.
- Persistent albuminuria in CRR patients warrants close monitoring and treatment optimization.
- This highlights the importance of considering albuminuria alongside proteinuria for comprehensive LN management and risk assessment.
Objective:
Systemic lupus erythematosus often leads to cardiovascular and renal complications, particularly in patients with lupus nephritis. In clinical practice, renal treatment response is commonly assessed using the Complete Renal Response criteria defined by the Consensus document of the Spanish Group for the Study of the Glomerular Diseases. These criteria, however, rely predominantly on proteinuria while albuminuria is often overlooked. The primary objective of our study was to assess the prevalence of pathological albuminuria in patients who met Complete Renal Response criteria. Secondary objectives included evaluating whether residual albuminuria identifies patients with different clinical outcomes.
Methods:
This single-centre, ambispective, observational study included 91 LN patients. Pathological albuminuria was defined as urinary albumin-creatinine ratio > 30 mg/g. Outcomes were compared between patients with and without pathological albuminuria despite achieving Complete Renal Response.
Results:
Among patients who met Complete Renal Response criteria, 80.5% had pathological albuminuria at the time of remission, and 55.8% continued to show it at the end of follow-up. Notably, patients with pathological albuminuria at the time of remission had significantly higher proteinuria levels both at disease onset and remission. Furthermore, persistent pathological albuminuria at follow-up was associated with more intensive antiproteinuric treatment. This therapeutic approach led to a significant reduction in both proteinuria and albuminuria titers.
Conclusion:
Pathological albuminuria remains common in lupus nephritis patients who meet Complete Renal Response criteria. Although cardiovascular events were infrequent during follow-up, the presence of persistent pathological albuminuria in patients meeting Complete Renal Response criteria underscores the need for close monitoring and therapeutic optimization, given its well-established association with adverse renal and cardiovascular outcomes in other glomerular diseases.
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