SavedAdd your journal

Journals / Akdeniz Tıp Dergisi / 2026 / Cilt: 12 Sayı: 1

Evaluation of the Prognostic Value of Proteinuria Severity in Predicting the Development of Lupus Nephritis in Patients with Systemic Lupus Erythematosus

Sistemik Lupus Eritematozuslu Hastalarda Lupus Nefriti Gelişimini Tahmin Etmede Proteinüri Şiddetinin Prognostik Değerinin Değerlendirilmesi

Mine Nokay(AKDENİZ ÜNİVERSİTESİ)0000-0001-5442-0121
Funda Erbasan(AKDENİZ ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, ROMATOLOJİ BİLİM DALI)0000-0001-9960-5664
V Yazisiz(AKDENİZ ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, ROMATOLOJİ BİLİM DALI)0000-0002-3176-4850
Mustafa Ender Terzioğlu(AKDENİZ ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, ROMATOLOJİ BİLİM DALI)0000-0002-1228-7323
Pages
—
Publication Date
2026-10-07
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

This threshold may improve early risk stratification compared to the conventional 500 mg/day cutoff.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objective: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease where lupus nephritis (LN) remains a leading cause of morbidity.
📊
Key Findings & Data:Proteinuria is a hallmark of renal involvement, but the prognostic value of lower thresholds ( 300 mg/day at diagnosis predicts LN development in patients with SLE and to identify associated clinical and serological risk factors.
💡
Conclusion & Impact:This threshold may improve early risk stratification compared to the conventional 500 mg/day cutoff.
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:Sistemik lupus eritematozus · lupus nefriti · proteinüri

Abstract

Objective: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease where lupus nephritis (LN) remains a leading cause of morbidity. Proteinuria is a hallmark of renal involvement, but the prognostic value of lower thresholds ( 300 mg/day at diagnosis predicts LN development in patients with SLE and to identify associated clinical and serological risk factors. Materials and Methods: This retrospective single-center study analyzed 140 SLE patients (90% female; mean age 43.8 ± 11.8 years) diagnosed at a tertiary rheumatology clinic. Data on demographics, organ involvement, serological markers (ANA, anti-dsDNA, C3/C4), SLE Disease Activity Index (SLEDAI), and 24-hour proteinuria were collected. Patients were stratified by proteinuria levels ( 300 mg/day) and followed for LN development. Logistic regression identified predictors of renal involvement. Results: Of 140 patients, 33 (23.6%) developed LN during follow-up. Patients with proteinuria >300 mg/day at baseline had significantly higher SLEDAI scores (21.7 vs. 8.3, p 300 mg/day independently predicted LN (OR=1.008, 95% CI=1.001–1.014, p=0.021). Conclusion: Proteinuria >300 mg/day at SLE diagnosis is a robust predictor of LN, associated with higher disease activity, hypocomplementemia, and anti-dsDNA positivity. This threshold may improve early risk stratification compared to the conventional 500 mg/day cutoff.

Özet

Amaç: Sistemik lupus eritematozus (SLE), çoklu organ tutulumu olan otoimmün bir hastalıktır ve lupus nefriti (LN) morbiditenin önde gelen nedenlerinden biridir. Proteinüri renal tutulumun temel göstergesi olmakla birlikte, LN’i öngörmede daha düşük eşiklerin ( 300 mg/gün olmasının SLE hastalarında LN gelişimini öngörüp öngörmediğini ve ilişkili klinik/serolojik risk faktörlerini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif, tek merkezli çalışmada, üçüncü basamak romatoloji kliniğinde tanı alan 140 SLE hastası (%90 kadın; ortalama yaş 43,8 ± 11,8 yıl) incelendi. Demografik veriler, organ tutulumları, serolojik belirteçler (ANA, anti-dsDNA, C3/C4), SLE Hastalık Aktivite İndeksi (SLEDAI) ve 24 saatlik proteinüri kaydedildi. Hastalar proteinüri düzeyine göre ( 300 mg/gün) sınıflandırıldı ve LN gelişimi açısından izlendi. Renal tutulumun belirleyicilerini saptamak için lojistik regresyon kullanıldı. Bulgular: Toplam 140 hastanın 33’ünde (%23,6) takip sürecinde LN gelişti. Başlangıçta proteinürisi >300 mg/gün olan hastalarda SLEDAI skorları anlamlı derecede yüksekti (21,7’ye karşı 8,3; p 300 mg/gün olmasının LN’ini bağımsız olarak öngördüğünü doğruladı (OR=1,008; %95 GA=1,001–1,014; p=0,021). Sonuç: SLE tanısında günde >300 mg proteinüri, LN için güçlü bir prediktör olup; daha yüksek hastalık aktivitesi, hipokomplementemi ve anti-dsDNA pozitifliği ile ilişkilidir. Bu 300 mg/gün eşik değeri, geleneksel 500 mg/gün değerine kıyasla erken bir LN risk sınıflandırmasını sağlayabilir.

🔖

Cite This Article

Nokay, M., Erbasan, F., Yazisiz, V., Terzioğlu, M. E. (2026). Evaluation of the Prognostic Value of Proteinuria Severity in Predicting the Development of Lupus Nephritis in Patients with Systemic Lupus Erythematosus. Akdeniz Tıp Dergisi, Cilt: 12 Sayı: 1. https://doi.org/10.53394/akd.1797576

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (19)

  1. Uramoto KM, Michet CJ Jr, Thumboo J, Sunku J, O'Fallon WM, Gabriel SE. Trends in the incidence and mortality of systemic lupus erythematosus 1950-1992. Arthritis Rheum.1999; 42(1): 46-50.
  2. Anstey NM, Bastian I, Dunckley H, Currie BJ. Systemic lupus erythematosus in Australian Aborigines: high prevalence, morbidity and mortality. Aust N Z J Med.1993; 23(6): 646-51.
  3. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 2003; 82(5): 299-308.
  4. Somers EC, Marder W, Cagnoli P, Lewis EE, DeGuire P, Gordon C, Helmick CG, Wang L, Wing JJ, Dhar JP, Leisen J, Shaltis D, McCune WJ. Population-based incidence and prevalence of systemic lupus erythematosus: The Michigan Lupus Epidemiology and Surveillance program. Arthritis Rheumatol.2014; 66(2): 369-78.
  5. Akbay FG. Prognostic factors and survival analysis of Systemic Lupus Erythematosus in Turkish patients. [medical specialization thesis]. Istanbul: Marmara University, Faculty of Medicine, Department of Internal Medicine; 2010. Turkish.
  6. Hahn BH. Systemic lupus erythmatosus. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, Eds. Harrison’s Principles of Internal Medicine 16th Ed. London, London: McGraw-Hill; 2005. p. 1960-8.
  7. Fanouriakis A, Kostopoulou M, Anders HJ, Andersen J, Aringer M, Beresford MW, Doria A, Frangou E, Furie R, Gladman DD, Houssiau F, Karras A, Kouloumas M, Madenidou AV, Malvar A, Marinaki S, Mok CC, Moroni G, Parodis I, Rednic S, Santos CS, Scire CA, Smolen JS, Tamirou F, Tanaka Y, Teng YKO, Welin E, Bertsias G, Boumpas DT. EULAR recommendations for the management of systemic lupus erythematosus with kidney involvement: 2025 update. Ann Rheum Dis. 2026; 85(1):75-90.
  8. Kidney Disease: Improving Global Outcomes (KDIGO) Lupus Nephritis Work Group. KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS. Kidney Int. 2024; 105(1S):S1-S69.
  9. Christopher-Stine L, Siedner M, Lin J, Haas M, Parekh H, Petri M, Fine DM. Renal biopsy in lupus patients with low levels of proteinuria. J Rheumatol.2007; 34(2): 332-5.
  10. Hsieh YP, Wen YK, Chen ML. The value of early renal biopsy in systemic lupus erythematosus patients presenting with renal involvement. Clin Nephrol.2012; 77(1): 18-24.
  11. Ginzler EM, Dooley MA, Aranow C, Kim MY, Buyon J, Merrill JT. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med.2005; 353(21): 2219-28.
  12. Fanouriakis A, Kostopoulou M, Andersen J, Aringer M, Arnaud L, Bae SC, Boletis J, Bruce IN, Cervera R, Doria A, Dörner T, Furie RA, Gladman DD, Houssiau FA, Inês LS, Jayne D, Kouloumas M, Kovács L, Mok CC, Morand EF, Moroni G, Mosca M, Mucke J, Mukhtyar CB, Nagy G, Navarra S, Parodis I, Pego-Reigosa JM, Petri M, Pons-Estel BA, Schneider M, Smolen JS, Svenungsson E, Tanaka Y, Tektonidou MG, Teng YO, Tincani A, Vital EM, van Vollenhoven RF, Wincup C, Bertsias G, Boumpas DT. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis.2024; 83(1): 15-29.
  13. Houssiau FA, Vasconcelos C, D'Cruz D, Sebastiani GD, de Ramon Garrido E, Danieli MG, Abramovicz D, Blockmans D, Cauli A, Direskeneli H, Galeazzi M, Gül A, Levy Y, Petera P, Popovic R, Petrovic R, Sinico RA, Cattaneo R, Font J, Depresseux G, Cosyns JP, Cervera R. The 10-year follow-up data of the Euro-Lupus nephritis trial comparing low-dose and high-dose intravenous cyclophosphamide. Ann Rheum Dis.2010; 69(1): 61-4.
  14. Maneiro JR, Lopez-Canoa N, Salgado E, Gomez-Reino JJ. Maintenance therapy of lupus nephritis with mycophenolate or azathioprine: systematic review and meta-analysis. Rheumatology (Oxford) 2014; 53(5): 834-8.
  15. Gomez Mendez LM, Cascino MD, Garg J, Katsumoto TR, Brakeman P, Dall'Era M, Looney RJ, Rovin B, Dragone L, Brunetta P. Peripheral blood B cell depletion after rituximab and complete response in lupus nephritis. Clin J Am Soc Nephrol. 2018; 13(10): 1502-9.
  16. Navarra SV, Guzmán RM, Gallacher AE, Hall S, Levy RA, Jimenez RE, Li EK, Thomas M, Kim HY, León MG, Tanasescu C, Nasonov E, Lan JL, Pineda L, Zhong ZJ, Freimuth W, Petri MA; BLISS-52 Study Group. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011; 377(9767): 721-31.
  17. Furie R, Petri M, Zamani O, Cervera R, Wallace DJ, Tegzová D, Sanchez-Guerrero J, Schwarting A, Merrill JT, Chatham WW, Stohl W, Ginzler EM, Hough DR, Zhong ZJ, Freimuth W, van Vollenhoven RF; BLISS-76 Study Group. A phase III, randomized, placebo-controlled study of belimumab, a monoclonal antibody that inhibits B lymphocyte stimulator, in patients with systemic lupus erythematosus. Arthritis Rheum. 2011; 63(12): 3918-30.
  18. Furie R, Rovin BH, Houssiau F, Malvar A, Teng YKO, Contreras G, Amoura Z, Yu X, Mok CC, Santiago MB, Saxena A, Green Y, Ji B, Kleoudis C, Burriss SW, Barnett C, Roth DA. Two-year, randomized, controlled trial of belimumab in lupus nephritis. N Engl J Med. 2020; 383(12): 1117-28.
  19. Pamuk ON, Akbay FG, Dönmez S, Yilmaz N, Calayir GB, Yavuz S. The clinical manifestations and survival of systemic lupus erythematosus patients in Turkey: report from two centers. Lupus. 2013; 22(13): 1416-24.