TY - JOUR
TI - A proteinuria cut-off level of 0.7 g /day after 12 months of treatment best predicts long-term renal outcome in lupus nephritis: Data from the MAINTAIN Nephritis Trial
AU - Tamirou, F.
AU - Lauwerys, B.R.
AU - Dall'Era, M.
AU - Mackay, M.
AU - Rovin, B.
AU - Cervera, R.
AU - Houssiau, F.A.
AU - Abramowicz, D.
AU - Atzeni, F.
AU - Blockmans, D.
AU - Danieli, M.G.
AU - De Clercq, L.
AU - D'Cruz, D.
AU - Del Mar Ayala Guttierez, M.
AU - De Ramon Garrido, E.
AU - Gilboe, I.-M.
AU - De Keyser, F.
AU - Delahousse, M.
AU - Espinosa, G.
AU - Fiehn, C.
AU - Golstein, M.
AU - Guillevin, L.
AU - Hirsch, M.
AU - Karras, A.
AU - Lang, P.
AU - Le Guern, V.
AU - Marchal, M.
AU - Marinho, A.
AU - Max, R.
AU - Peeters, P.
AU - Petera, P.
AU - Petrovic, R.
AU - Quémeneur, T.
AU - Raeman, F.
AU - Remy, P.
AU - Ravelingien, I.
AU - Sarzi-Puttini, P.
AU - Sangle, S.
AU - Tektonidou, M.
AU - De Santis, L.V.
AU - Vasconcelos, C.
AU - Verresen, L.
AU - Weiss, L.
AU - Westhovens, R.
AU - MAINTAIN Nephritis Trial investigators
JO - Lupus Science and Medicine
PY - 2015
VL - 2
TODO - 1
SP - null
PB - BMJ Publishing Group
SN - null
TODO - 10.1136/lupus-2015-000123
TODO - Article;  controlled study;  erythrocyte count;  female;  follow up;  human;  kidney function;  lupus erythematosus nephritis;  major clinical study;  male;  multicenter study;  outcome assessment;  predictive value;  priority journal;  proteinuria;  randomized controlled trial;  receiver operating characteristic;  sensitivity and specificity;  task performance;  treatment duration;  urinalysis;  validation study
TODO - Background: Although an early decrease in proteinuria has been correlated with good long-term renal outcome in lupus nephritis (LN), studies aimed at defining a cut-off proteinuria value are missing, except a recent analysis performed on patients randomised in the Euro-Lupus Nephritis Trial, demonstrating that a target value of 0.8 g/day at month 12 optimised sensitivity and specificity for the prediction of good renal outcome. The objective of the current work is to validate this target in another LN study, namely the MAINTAIN Nephritis Trial (MNT). Methods: Long-term (at least 7 years) renal function data were available for 90 patients randomised in the MNT. Receiver operating characteristic curves were built to test the performance of proteinuria measured within the 1st year as short-term predictor of long-term renal outcome. We calculated the positive and negative predictive values (PPV, NPV). Results: After 12 months of treatment, achievement of a proteinuria <0.7 g/day best predicted good renal outcome, with a sensitivity and a specificity of 71% and 75%, respectively. The PPV was high (94%) but the NPV low (29%). Addition of the requirement of urine red blood cells ≤5/hpf as response criteria at month 12 reduced sensitivity from 71% to 41%. Conclusions: In this cohort of mainly Caucasian patients suffering from a first episode of LN in most cases, achievement of a proteinuria <0.7 g/day at month 12 best predicts good outcome at 7 years and inclusion of haematuria in the set of criteria at month 12 undermines the sensitivity of early proteinuria decrease for the prediction of good outcome. The robustness of these conclusions stems from the very similar results obtained in two distinct LN cohorts.
ER -