Four trajectories of 24-hour urine protein levels in real-world lupus nephritis cohorts

Abstract

ObjectivesA 24-hour urine protein (24hUP) is a key measurement in the management of lupus nephritis (LN); however, trajectories of 24hUP in LN is poorly defined.MethodsTwo LN cohorts that underwent renal biopsies at Renji Hospital were included. Patients received standard of care in a real-world setting and 24hUP data were collected over time. Trajectory patterns of 24hUP were determined using the latent class mixed modelling (LCMM). Baseline characters were compared among trajectories and multinomial logistic regression was used to determine independent risk factors. Optimal combinations of variables were identified for model construction and user-friendly nomograms were developed.ResultsThe derivation cohort composed of 194 patients with LN with 1479 study visits and a median follow-up of 17.5 (12.2–21.7) months. Four trajectories of 24hUP were identified, that is, Rapid Responders, Good Responders, Suboptimal Responders and Non-Responders, with the KDIGO renal complete remission rates (time to complete remission, months) of 84.2% (4.19), 79.6% (7.94), 40.4% (not applicable) and 9.8% (not applicable), respectively (p<0.001). The ‘Rapid Responders’ distinguish itself from other trajectories and a nomogram, composed of age, systemic lupus erythematosus duration, albumin and 24hUP yielded C-indices >0.85. Another nomogram to predict ‘Good Responders’ yielded C-indices of 0.73~0.78, which composed of gender, new-onset LN, glomerulosclerosis and partial remission within 6 months. When applied to the validation cohort with 117 patients and 500 study visits, nomograms effectively sorted out ‘Rapid Responders’ and ‘Good Responders’.ConclusionFour trajectories of LN shed some light to guide the management of LN and further clinical trials design.

Value of SLE-DAS in assessing disease activity in patients with systemic lupus erythematosus: a single-centre retrospective study

“… 15 However, isolated urinary casts, haematuria and pyuria are usually not clinical manifestations of severe lupus nephritis, whereas urinary abnormalities accompanied by proteinuria often attract the attention of clinicians and reflect the activity of lupus nephritis. 28 The correlation coefficients of the SLE-DAS value and the SLEDAI 2000 value were the same in terms of proteinuria (ρ=0.472 vs 0.490). The SLEDAI 2000 scored urinary casts, haematuria, pyuria and proteinuria similarly with weighted dichotomy, independent of the level.…”

Combination of anti-SSA/Ro60 and anti-dsDNA serotype is predictive of belimumab renal response in patients with lupus nephritis

“…For renal set, proteinuria has been linked to belimumab renal response according to Belimumab International Study in Lupus Nephritis (BLISS-LN) post hoc analyses, 14 thus, was enclosed to further modelling. Because median (IQR) LN duration was relatively shorter among patients displaying positive anti-SSA/Ro60 (1.0 (0.0–4.9) vs 3.5 (0.1–8.0), p=0.088), and new-onset LN was reported to predict good renal response, 15 LN duration was also included. To be thorough, since prednisone and CNI had already been included as putative predictors, HCQ, MMF or CYC exposures were not left behind and all subjected to multivariable analyses.…”