{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T18:09:32Z","timestamp":1784138972732,"version":"3.55.0"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T00:00:00Z","timestamp":1650931200000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01-AR069572"],"award-info":[{"award-number":["R01-AR069572"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["T32-AR048522"],"award-info":[{"award-number":["T32-AR048522"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2022,3,29]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Treatment response in lupus nephritis (LN) is defined based on proteinuria, yet protocol kidney biopsy studies have shown that patients with lupus can have active nephritis in the absence of proteinuria. Using estimated glomerular filtration rate (eGFR) trajectories, we characterised early chronic kidney disease in LN and examined whether certain patients continue to accrue renal damage despite proteinuric response.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a single-centre study of patients diagnosed with their first episode of biopsy-proven class III, IV, and\/or V LN (n=37). For each patient, eGFR trajectory was graphed over 5\u2009years following renal biopsy. Participants were divided into those with progressive eGFR loss (eGFR slope &lt;\u22125 mL\/min\/1.73 m<jats:sup>2<\/jats:sup>\/year) versus those with stable eGFR. Participant demographics, renal biopsy features and response status at 1\u2009year (urine protein to creatinine ratio &lt;500\u2009mg\/g) were compared between eGFR trajectory groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 30% (n=11) of participants accrued progressive eGFR loss despite standard of care therapy over the first 5\u2009years following renal biopsy. There were no significant differences in baseline renal biopsy features, medication regimens or comorbidities between eGFR trajectory groups. Resolution of proteinuria at 1\u2009year did not differentiate between groups: 6 of 18 (33%) of complete responders continued to accrue renal damage compared with 5 of 17 (29%) of non-responders. Response status could not be assigned for two participants in the stable eGFR group due to missing clinical information at 1\u2009year.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We identified an understudied category of patients with LN who accrue progressive renal damage despite apparent response to standard of care therapy. Better definitions and biomarkers of response are needed to improve renal outcomes and trial design.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/lupus-2022-000684","type":"journal-article","created":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T09:15:18Z","timestamp":1651742118000},"page":"e000684","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["One-third of patients with lupus nephritis classified as complete responders continue to accrue progressive renal damage despite resolution of proteinuria"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4396-4013","authenticated-orcid":false,"given":"Emma","family":"Weeding","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6738-4836","authenticated-orcid":false,"given":"Andrea","family":"Fava","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Magder","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Goldman","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1441-5373","authenticated-orcid":false,"given":"Michelle","family":"Petri","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,5,5]]},"reference":[{"key":"2025091512153820000_9.1.e000684.1","doi-asserted-by":"publisher","DOI":"10.1191\/0961203305lu2238oa"},{"key":"2025091512153820000_9.1.e000684.2","doi-asserted-by":"publisher","DOI":"10.1002\/art.30293"},{"key":"2025091512153820000_9.1.e000684.3","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e31827f4ee3"},{"key":"2025091512153820000_9.1.e000684.4","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.161554"},{"key":"2025091512153820000_9.1.e000684.5","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.191094"},{"key":"2025091512153820000_9.1.e000684.6","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110532"},{"key":"2025091512153820000_9.1.e000684.7","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000829"},{"key":"2025091512153820000_9.1.e000684.8","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv296"},{"key":"2025091512153820000_9.1.e000684.9","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.kint.2018.05.021","article-title":"A prospective observational cohort study highlights kidney biopsy findings of lupus nephritis patients in remission who flare following withdrawal of maintenance therapy","volume":"94","author":"De Rosa","year":"2018","journal-title":"Kidney Int"},{"key":"2025091512153820000_9.1.e000684.10","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1016\/j.ekir.2020.09.007","article-title":"Low-Level proteinuria in systemic lupus erythematosus","volume":"5","author":"Chedid","year":"2020","journal-title":"Kidney Int Rep"},{"key":"2025091512153820000_9.1.e000684.11","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1053\/j.ajkd.2019.06.009","article-title":"Change in albuminuria and GFR as end points for clinical trials in early stages of CKD: a scientific workshop sponsored by the National kidney Foundation in collaboration with the US food and drug administration and European medicines Agency","volume":"75","author":"Levey","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"2025091512153820000_9.1.e000684.12","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"key":"2025091512153820000_9.1.e000684.13","doi-asserted-by":"publisher","DOI":"10.1038\/kisup.2012.73"},{"key":"2025091512153820000_9.1.e000684.14","doi-asserted-by":"crossref","first-page":"361","DOI":"10.2147\/IJNRD.S40172","article-title":"Diabetic nephropathy - 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