Urinary aberrations in systemic lupus erythematosus not always indicative of lupus nephritis: a cross-sectional cohort study

Author:

Karlsson LinneaORCID,Zickert Agneta,Svenungsson ElisabetORCID,Schmidt-Mende Jan,Faustini FrancescaORCID,Gunnarsson IvaORCID

Abstract

Abstract Introduction Kidney biopsy is the reference tool for diagnosing and guiding treatment strategies in inflammatory renal diseases, such as lupus nephritis (LN). We investigated the histopathological findings in first-time kidney biopsies from a large cohort of SLE patients. We focused on the occurrence and type of histopathological findings other than LN, and fulfillment of renal criteria in established SLE classification systems were analyzed. Methods We retrospectively included SLE patients (n = 139) who underwent a first kidney biopsy between 1995 and 2021, upon clinical suspicion of renal involvement. Based on histology, two groups were defined, LN and non-LN, for which clinical and laboratory features were compared. Results Findings consistent with LN according to ISN/RPS classification system were present in 123/139 patients (88.5%) and findings not consistent with LN were present in 16 /139 (11.5%). Non-LN patients were older at SLE diagnosis compared to LN patients (M, years 38.0 vs. 30.1, p=0.013) and had longer disease duration (M, years 11.9 vs 0.5) (p=0.027). Among non-LN patients 85.7% met the SLICC criteria item for renal SLE, seen in 94.7% in the LN group (ns). For the ACR/EULAR criteria, 66.7% of the non-LN group fulfilled the criteria compared to 74.8% in LN patients (ns). Proteinuria below the criteria cut-off level (< 0.5 g/24 h) was seen in 20% of patients with class III/IV LN. Conclusion Our data confirm the importance of kidney biopsy for ruling out the presence of renal pathology other than LN. Patients with low-grade proteinuria may exhibit severe types of LN, which reinforces the need for early biopsies to detect LN. Key PointsOur findings show that histopathology changes other than lupus nephritis may occur in a significant number of patients with clinical and laboratory signs of novel kidney involvement.Low-grade proteinuria does not exclude findings of active lupus nephritis that require the start of immunosuppressive therapy.The study stresses the importance of performing kidney biopsies also in the presence of low-grade proteinuria or when signs of kidney function abnormalities occur.This is crucial as early detection and prompt initiation of therapy may improve outcomes in lupus nephritis.

Funder

ALF funding from Region Stockholm

Karolinska Institutet Foundation

The King Gustaf V 80th Birthday Fund

The Swedish Rheumatism Association

The Swedish Kidney Foundation

Stig and Gunborg Westman´s Foundation

Dr Margaretha Nilsson Foundation for medical research

Svenska Sällskapet för Medicinsk Forskning

Karolinska Institute

Publisher

Springer Science and Business Media LLC

Subject

General Medicine,Rheumatology

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