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

Autor:	Kharouf F; University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canaa., Li Q; University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canaa., Whittall Garcia LP; University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canaa., Gladman DD; University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canaa., Touma Z; University of Toronto Lupus Clinic, Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canaa.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Oct 24. Date of Electronic Publication: 2024 Oct 24.
DOI:	10.1093/rheumatology/keae579
Abstrakt:	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. (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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