Abstract
BackgroundTo investigate non-histologic factors that can discriminate proliferative lupus nephritis (LN) from membranous LN in patients with systemic lupus erythematosus with renal manifestations.MethodsPatients with biopsy-proven proliferative LN (class III ± V and class IV ± V) and membranous LN (class V) were included. Non-histologic factors were compared between the two groups. A logistic regression analysis was performed to identify the factors associated with proliferative LN. To assess the accuracy of these factors in discriminating between proliferative LN and membranous LN, we performed a receiver-operating characteristic analysis.ResultsOf the total 168 patients with biopsy-proven LN, 150 patients (89.3%) had proliferative LN, and 18 patients (10.7%) had membranous LN. In the multivariable logistic regression analysis, positive anti-double-stranded DNA (anti-dsDNA) antibody (adjusted OR = 11.200, 95% CI = 2.202–56.957, p = 0.004) was associated with proliferative LN, while positive anti-U1RNP antibody (adjusted OR = 0.176, 95% CI = 0.040–0.769, p = 0.021) and higher glomerular filtration rate (GFR) (adjusted OR = 0.973, 95% CI = 0.951–0.994, p = 0.013) were inversely associated with proliferative LN. Among these covariates, the anti-dsDNA antibody (area under the curve = 0.806, 95% CI = 0.695–0.916) had the highest accuracy in discriminating between proliferative LN and membranous LN.ConclusionThe positivity of anti-dsDNA antibody was associated with proliferative LN, while the positivity of anti-U1RNP antibody and GFR were inversely associated with proliferative LN. The anti-dsDNA antibody had a good accuracy in discriminating proliferative LN from membranous LN.
Highlights
To investigate non-histologic factors that can discriminate proliferative lupus nephritis (LN) from membranous LN in patients with systemic lupus erythematosus with renal manifestations
In comparison between pure proliferative LN and non-proliferative LN, anti-dsDNA Ab was associated with pure proliferative LN, and anti-U1RNP Ab and glomerular filtration rate (GFR) were inversely associated with pure proliferative LN, supporting their value in predicting proliferative LN (Table 6). In this retrospective cohort study, we showed that the positivity for and level of anti-dsDNA Ab were significantly associated with proliferative LN and that the positivity for and level of anti-U1RNP Ab and the GFR were inversely associated with proliferative LN
Considering that the value of renal biopsy and need for treatment is uncertain in silent LN [23], the covariates associated with proliferative LN in the patients with overt renal manifestations that we identified in this study still have clinical significance
Summary
To investigate non-histologic factors that can discriminate proliferative lupus nephritis (LN) from membranous LN in patients with systemic lupus erythematosus with renal manifestations. Lupus nephritis (LN) is one of the common manifestations of systemic lupus erythematosus (SLE) that causes significant morbidity and mortality [1]. Considering the differences in the treatment strategy and renal prognosis between proliferative LN and membranous LN, it is important to distinguish one from the other. The confirmative modality for diagnosing LN and distinguishing proliferative LN from membranous LN is renal biopsy [5]. Given that renal biopsies may not always be available, it is clinically meaningful to identify non-histologic factors that can discriminate proliferative LN from membranous LN
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