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Renal Biopsy in Lupus Patients with Low Levels of Proteinuria
LISA CHRISTOPHER-STINE, MARK SIEDNER, JANICE LIN, MARK HAAS, HEMAL PAREKH, MICHELLE PETRI, and DEREK M. FINE ABSTRACT. Objective. Early and accurate detection of kidney involvement in systemic lupus erythematosus (SLE) improves outcomes. Renal biopsy is required for definitive diagnosis of lupus nephritis (LN). In the absence of acute renal failure (ARF), moderate levels of proteinuria (> 1000 mg/24 h) have been recommended by some to justify biopsy. We investigated whether patients with lower levels of proteinuria without ARF have significant renal disease and should be routinely biopsied. Methods. We retrospectively evaluated 21 SLE patients with 24-h urine protein < 1000 mg who underwent kidney biopsies. Indications for biopsy included new-onset proteinuria, increasing proteinuria, or hematuria (> 5 red blood cells per high power field). No patient had ARF. Results. Sixteen of 21 (77%) biopsies were diagnostic of LN: 3 class II, 10 class III (5 superimposed class V), 2 class IV (one superimposed class V), and one with class V. One patient had thrombotic microangiopathy. The remaining 4 (23%) patients had non-lupus renal disease. Thirteen patients with class III or greater LN required alterations in therapeutic regimen because of biopsy findings. Of 7 patients without hematuria at the time of biopsy, 4 (57%) had class III, IV, or V LN. One patient without hematuria and < 500 mg/24 h proteinuria had class III LN. Conclusion. We found significant renal involvement (Class III, IV, or V LN) in SLE patients with < 1000 mg proteinuria with or without hematuria. Our findings suggest that biopsy be strongly considered in this patient population. (First Release Dec 15 2006; J Rheumatol 2007;34:332–5) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS From the Divisions of Nephrology and Rheumatology, Johns Hopkins University Department of Medicine, Baltimore, Maryland, USA. Dr. Christopher-Stine is supported by the Arthritis Foundation Postdoctoral Fellowship Award and The Johns Hopkins Clinician Scientist Career Development Award. The Johns Hopkins Lupus Cohort is supported by NIH AR43727 and the Johns Hopkins Clinical Research Center M-1-RR00052. L. Christopher-Stine, MD, MPH, Assistant Professor of Medicine; M. Siedner, MPH; J. C. Lin, BS; M. Haas, MD, Professor of Pathology; H.J. Parekh, MD; M. Petri, MD, MPH, Professor of Medicine; D.M. Fine, MD, Assistant Professor of Medicine. Address reprint requests to Dr. D.M. Fine, 1830 East Monument Street, Suite 416, Baltimore, MD 21205. E-mail: dfine1@jhmi.edu Accepted for publication August 23, 2006.
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