{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T19:49:04Z","timestamp":1782244144273,"version":"3.54.5"},"reference-count":20,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A kidney biopsy is essential for definitive histopathological diagnosis in lupus nephritis, informing therapeutic strategies. Current guidelines (ACR and EULAR\/ERA-EDTA) do not include a kidney biopsy for patients with isolated proteinuria of less than 500\u00a0mg\/g. We explored the histopathologic findings in patients with SLE with proteinuria \u2264500\u00a0mg\/g.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective review of 27 biopsies of lupus patients with proteinuria \u2264500\u00a0mg\/g who underwent a kidney biopsy at Johns Hopkins. Clinical and laboratory data were obtained from a review of the medical records. The study was approved by the Office of Human Subjects Research and Institutional Review Board.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most individuals were females (93%) and African American (56%), with a mean age of 42.1 (12.4) years at the time of biopsy. Twelve individuals had no prior history of lupus nephritis. The average creatinine at the biopsy was 1.05\u00a0mg\/dl, and UPCR was 0.27\u00a0grams\/gram. Most patients (100%) were on hydroxychloroquine, 41% were on prednisone, and 33% were on mycophenolate mofetil. Kidney biopsies were most commonly performed based on extra-renal disease activity, new-onset or worsening proteinuria (88.9%) and worsening dsdNA levels (55.6%). At the time of biopsy, 55.6% of patients presented with extrarenal lupus, most commonly arthritis or arthralgias and mucosal ulcers. Of the 27 patients, 23 patients had evidence of lupus nephritis (85.1%), including class III (33%), V (30%), III\/V (7%), class II (4%) and class I (11%). Nine patients had a UPCR of 200\u00a0mg\/g or lower. Among these patients, 22% did not show signs of lupus nephritis in the kidney biopsy, 44% had class V LN, and 11% had class I and III LN. Kidney biopsy was well tolerated, with the majority (93%) not developing post-biopsy complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We identified patients with proteinuria \u2264500\u00a0mg\/g who had lupus nephritis, with the majority ranging from Class III to V with only one class II. This study supports that normal or low UPCR &lt;500\u00a0mg\/g lacks the sensitivity to detect early lupus nephritis. Better biomarkers for the cutoff of biopsy are needed to improve kidney outcomes and trial design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09612033251321655","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T04:19:06Z","timestamp":1740111546000},"page":"331-336","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Association of low-grade proteinuria with changes of lupus nephritis in kidney biopsy in SLE patients"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8198-9089","authenticated-orcid":false,"given":"Homa","family":"Timlin","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2154-0893","authenticated-orcid":false,"given":"Abbal","family":"Koirala","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Gross","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duvuru","family":"Geetha","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ihab","family":"Kamel","sequence":"additional","affiliation":[{"name":"Division of Radiology, University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7572-9961","authenticated-orcid":false,"given":"Mohamed G.","family":"Atta","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0141-9"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203315604909"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-221662"},{"key":"e_1_3_3_5_2","first-page":"1891","article-title":"Routine immunologic tests in systemic lupus erythematosus: is there a need for more studies?","volume":"23","author":"Esdaile JM","year":"1996","unstructured":"Esdaile JM, Joseph L, Abrahamowicz M, et al. Routine immunologic tests in systemic lupus erythematosus: is there a need for more studies? J Rheumatol 1996; 23: 1891\u20131896.","journal-title":"J Rheumatol"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.20602"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-198105000-00004"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.094508"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2019121285"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.935700"},{"key":"e_1_3_3_11_2","unstructured":"Lupus Clinical. Practice guideline. https:\/\/rheumatology.org\/lupus-guideline"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110532"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000829"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv296"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2020.09.007"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2020.04.005"},{"key":"e_1_3_3_17_2","first-page":"1563","article-title":"Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure","volume":"33","author":"Faurschou M","year":"2006","unstructured":"Faurschou M, Starklint H, Halberg P, et al. Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure. J Rheumatol 2006; 33: 1563\u20131569.","journal-title":"J Rheumatol"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-023-00925-5"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0961203310371154"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/106904"},{"key":"e_1_3_3_21_2","first-page":"1495","article-title":"Multiple autoantibodies form the glomerular immune deposits in patients with systemic lupus erythematosus","volume":"30","author":"Mannik M","year":"2003","unstructured":"Mannik M, Merrill CE, Stamps LD, et al. Multiple autoantibodies form the glomerular immune deposits in patients with systemic lupus erythematosus. J Rheumatol 2003; 30: 1495\u20131504.","journal-title":"J Rheumatol"}],"container-title":["Lupus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09612033251321655","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09612033251321655","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09612033251321655","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:28:41Z","timestamp":1777678121000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09612033251321655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,21]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1177\/09612033251321655"],"URL":"https:\/\/doi.org\/10.1177\/09612033251321655","relation":{},"ISSN":["0961-2033","1477-0962"],"issn-type":[{"value":"0961-2033","type":"print"},{"value":"1477-0962","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,21]]}}}