TOPLINE

In patients with systemic lupus erythematosus (SLE) with glomerular hematuria, the presence of anti-dsDNA antibodies, higher proteinuria, and more extra-renal disease activity predicted clinically significant lupus nephritis, while glomerular hematuria on its own rarely did.

METHODOLOGY

• Researchers conducted a cross-sectional study to examine renal presentation patterns in patients with SLE who underwent a first diagnostic kidney biopsy and to evaluate the diagnostic value of glomerular hematuria and predictors of clinically significant lupus nephritis.
• The analysis included 227 patients (median age, 36 years; 81.9% women) from two independent centers in Greece and Türkiye between 2000 and 2025.
• Glomerular hematuria was categorized as isolated (hematuria alone) or combined with proteinuria, impaired kidney function, or both. Overall, 137 patients had glomerular hematuria.
• Clinically significant lupus nephritis was identified using standard criteria. A predictive model was developed for clinically significant lupus nephritis in patients with glomerular hematuria, and its discrimination was assessed using area under the receiver operating characteristic curve (AUC).

TAKEAWAY

• Overall, 79.7% of patients showed clinically significant lupus nephritis and 15.9% showed non-lupus nephritis pathology.
• Of 11 patients with isolated glomerular hematuria, 9 had non-lupus kidney diagnoses and 2 had lupus nephritis, both with serologic activity.
• Among patients with glomerular hematuria, 81.8% had clinically significant lupus nephritis.
• Independent predictors of clinically significant lupus nephritis included anti-dsDNA positivity, higher proteinuria per 1 g per day, higher non-renal clinical SLE disease activity index per point, and younger age (P ≤ .05 for all). The final model demonstrated good discriminative ability (AUC 0.94) and adequate calibration.

IN PRACTICE

"Our results highlight the importance of integrating urinary findings with serologic and clinical indicators of disease activity, in a holistic approach to guide the need for kidney biopsy in patients with lupus," the authors of the study wrote.

SOURCE

The study was led by Konstantinos Drougkas, National and Kapodistrian University of Athens, Greece. It was published online on August 7 in Rheumatology International.

LIMITATIONS

The small sample size of patients with isolated glomerular hematuria may have restricted the generalizability of the findings. Some patients with hematuria did not undergo kidney biopsy and were therefore not included in the analysis. Records of treatments at the time of the kidney biopsy were incomplete.

DISCLOSURES

The study did not receive any funding. The authors did not report any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.