Rheumatology Advance Access originally published online on November 28, 2006
Rheumatology 2007 46(4):683-689; doi:10.1093/rheumatology/kel347
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Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) XL II: factors predictive of new or worsening proteinuria
1Department of Medicine, Division of Clinical Immunology and Rheumatology, 2Department of Epidemiology, 3School of Medicine and Public Health, Surgery (Section of Trauma and Burns and Critical Care) and The University of Alabama, Birmingham, 4Department of Internal Medicine, Division of Rhematology, University of Puerto Rico, San Juan, Puerto Rico and 5Department of Medicine, Division of Rheumatology, University of Texas Health Science Center, Houston, Texas.
Correspondence to: Graciela S. Alarcón, MD, MPH, 830 Faculty Office Tower, 1530 3rd Ave S, Birmingham, AL, 35294-3408, USA. E-mail: graciela.alarcon{at}ccc.uab.edu
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Abstract |
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Objectives. To determine the factors predictive of new or worsening proteinuria in a large multiethnic cohort of patients with systemic lupus erythematosus (SLE).
Methods. Five hundred and twenty-nine SLE patients from a multiethnic US cohort [LUpus in MInorities: NAture versus Nurture (LUMINA)] were evaluated for new or worsening proteinuria using the categories of the Systemic Lupus Activity Measure-Revised: (1), normal; (2), trace or 1+ proteinuria on the dipstick; (3), 2–3+ proteinuria and (4), 
4+ proteinuria. A rise in urinary protein was considered a positive event visit. Basic demographic and socioeconomic variables were assessed at baseline (T0). Clinical and immunological variables including disease features, activity, duration, comorbidities (such as hypertension and diabetes), medications and autoantibodies were assessed at the visit preceding a positive event visit. Selected HLA-DR and HLA-DQ alleles, and FCGR receptor polymorphisms were assessed. Data were analysed using logistic regression analyses and generalized estimating equations.
Results. There were 243 patients (59.1% of 93 Texan Hispanics, 37.0% of 100 Puerto Rican Hispanics, 58.0% of 181 African Americans and 29.7% of 155 Caucasians) with new or worsening proteinuria, and 364 positive events in 2801 visits. Younger age [Odds ratio (OR) = 1.013, 95% confidence limits (CL) = 1.001–1.024, P < 0.0334], anti-dsDNA (OR = 1.554, CL = 1.149–2.100, P < 0.0042), and HLA-DRB1*1503 (OR = 1.746, 95% CL = 1.573–2.2673, P < 0.0103) were found to independently predict the occurrence of new or worsening proteinuria.
Conclusion. The factors predictive of new or worsening proteinuria include traditional factors associated with lupus nephritis, such as age and anti-dsDNA, as well as HLA-DRB1*1503, which has not been previously described in association with lupus nephritis, new or worsening proteinuria.
KEY WORDS: SLE, New or worsening proteinuria, Predictors
*Current LUMINA investigators and staff:
The University of Alabama at Birmingham: Graciela S. Alarcón, MD, MPH, Holly M. Bastian, MD, MSPH, Barri J. Fessler, MD, Gerald McGwin, Jr, MS, PhD, Jeffrey M. Roseman, MD, MPH, PhD, Mónica Fernández, MD, Rosa Andrade, MD, Martha L. Sanchez, MD, MPH, Ellen Sowell, AA and Bernadette Johnson, BS.
The University of Texas Health Science Center at Houston: John D. Reveille, MD and Robert Sandoval, BA.
The University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico: Luis M. Vilá, MD and Carmine Pinilla-Diaz, MT.
Submitted 12 February 2006;
revised version accepted 8 September 2006.
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