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The following is a summary of “Nomogram for predicting proliferative lupus nephritis in patients with low-level proteinuria,” published in the January 2025 issue of Rheumatology by Lu et al.

Proliferative lupus nephritis (LN) can occur with proteinuria < 0.5 g/24h, highlighting the need for early prediction. Early prediction aids effective management. 

Researchers conducted a retrospective study to develop a predictive model for proliferative LN in patients with low-level proteinuria.

They enrolled 671 patients with biopsy-proven LN, divided into low-level proteinuria (< 0.5 g/24 h) and high-level proteinuria (≥ 0.5 g/24 h) groups. Clinical features, pathological characteristics, and long-term outcomes were compared between groups. They used least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression to develop a predictive nomogram for proliferative nephritis in low-level proteinuria patients, with internal validation via bootstrap resampling. 

The results showed 103 of 671 (15.4%) patients with LN had low-level proteinuria, with 43 (41.7%) showing proliferative LN. The activity index was 5 (IQR [4,7]) and the chronicity index was 3 (IQR [2,4]). The low-level proteinuria group had better long-term adverse renal events-free survival. LASSO-logistic regression identified age, sex, mean arterial pressure, hemoglobin, platelet, 24-h proteinuria, and anti-double-strand DNA antibodies as predictors. The model had an area under the curve of 0.900 (95% CI: 0.840–0.960) and a bootstrapped result of 0.894 (95% CI: 0.832–0.965), with good calibration. 

Investigators found that 41.7% of low-level proteinuria patients had proliferative LN on biopsy. The nomogram effectively predicted proliferative LN before biopsy. 

Source: academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/keaf015/7958598