Low-level proteinuria at the initial diagnosis of systemic lupus erythematosus significantly increases the risk of developing proteinuria-predominant lupus nephritis
5 affiliations
- 1Department of Rheumatology, Sanming First Hospital Affiliated to Fujian Medical University, Sanming, China.
- 2Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China.
- 3Department of Rheumatology, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China.
- 4Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China.
- 5Fujian Institute of Clinical Immunology, Fujian Medical University Union Hospital, Fuzhou, China.
Abstract
Purpose: A proportion of patients with systemic lupus erythematosus (SLE) present with subclinical low-level proteinuria at initial diagnosis that does not meet the formal classification criteria for lupus nephritis (LN). This study aimed to investigate the association between low-level proteinuria at SLE onset and the risk of developing proteinuria-predominant LN. Patients and methods: This was a retrospective cohort study using medical records of patients newly diagnosed with SLE from Fujian Medical University Union Hospital between December and March. Inclusion required urine dipstick proteinuria ≤2+; if quantified, protein excretion <500 mg/24h (by the urine protein-to-creatinine ratio [UPCR] or 24-hour proteinuria). Demographic, clinical, and laboratory data were collected at the time of initial diagnosis, as well as urinalysis, urine sediment, UPCR, and 24-hour proteinuria during follow-up, where available. The association between various baseline variables and the subsequent development of proteinuria-predominant LN was analyzed using a Cox proportional hazards model. Results: Of 330 patients screened, 297 were eligible for inclusion in the final analysis, of whom 85 patients had low-level proteinuria at the initial diagnosis. According to multivariable-adjusted models, low-level proteinuria significantly increased the risk of proteinuria-predominant LN (P < 0.001, hazard ratio[HR] = 3.355, 95% confidence interval [CI]: 1.6646.765), as did male sex (P = 0.001, HR = 3.178, 95% CI: 1.563–6.460). Conclusion: This study highlights that SLE patients with low-level proteinuria at initial diagnosis may require enhanced monitoring for LN, enabling early detection. Future studies are needed to determine the necessity of early intervention.
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BibTeX
@article{song2026lowlevel,
title = {{Low-level proteinuria at the initial diagnosis of systemic lupus erythematosus significantly increases the risk of developing proteinuria-predominant lupus nephritis}},
author = {Minghui Song and Guolong Xu and Fengxian Xu and Shengkai Zhang and Qinqin Wang and Wenjing Xue and Ruiying Chen and Lixin Wei and He-Jun Li},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0361288},
url = {https://doi.org/10.1371/journal.pone.0361288},
note = {CC BY},
}
RIS
TY - JOUR
TI - Low-level proteinuria at the initial diagnosis of systemic lupus erythematosus significantly increases the risk of developing proteinuria-predominant lupus nephritis
AU - Minghui Song
AU - Guolong Xu
AU - Fengxian Xu
AU - Shengkai Zhang
AU - Qinqin Wang
AU - Wenjing Xue
AU - Ruiying Chen
AU - Lixin Wei
AU - He-Jun Li
PY - 2026
DA - 2026/10/29
JO - PLOS One
DO - 10.1371/journal.pone.0361288
UR - https://doi.org/10.1371/journal.pone.0361288
AB - Purpose: A proportion of patients with systemic lupus erythematosus (SLE) present with subclinical low-level proteinuria at initial diagnosis that does not meet the formal classification criteria for lupus nephritis (LN). This study aimed to investigate the association between low-level proteinuria at SLE onset and the risk of developing proteinuria-predominant LN. Patients and methods: This was a retrospective cohort study using medical records of patients newly diagnosed with SLE from Fujian Medical University Union Hospital between December and March. Inclusion required urine dipstick proteinuria ≤2+; if quantified, protein excretion <500 mg/24h (by the urine protein-to-creatinine ratio [UPCR] or 24-hour proteinuria). Demographic, clinical, and laboratory data were collected at the time of initial diagnosis, as well as urinalysis, urine sediment, UPCR, and 24-hour proteinuria during follow-up, where available. The association between various baseline variables and the subsequent development of proteinuria-predominant LN was analyzed using a Cox proportional hazards model. Results: Of 330 patients screened, 297 were eligible for inclusion in the final analysis, of whom 85 patients had low-level proteinuria at the initial diagnosis. According to multivariable-adjusted models, low-level proteinuria significantly increased the risk of proteinuria-predominant LN (P < 0.001, hazard ratio[HR] = 3.355, 95% confidence interval [CI]: 1.6646.765), as did male sex (P = 0.001, HR = 3.178, 95% CI: 1.563–6.460). Conclusion: This study highlights that SLE patients with low-level proteinuria at initial diagnosis may require enhanced monitoring for LN, enabling early detection. Future studies are needed to determine the necessity of early intervention.
SN - 1932-6203
ER -