Lupus nephritis: serum albumin at 1 year predicts long-term renal outcome

  • Domingues V & al.
  • Lupus Sci Med
  • 1 Jan 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • A serum albumin level of >3.7 g/dL at 1 year postbiopsy for lupus nephritis (LN) predicts a favorable renal outcome 3 years later. 
  • Levels below this cutoff predict negative renal outcomes.

Why this matters

  • LN has 40%-60% morbidity or mortality.
  • Serum albumin is a new prognostic biomarker that can guide treatment decisions to prevent long-term disease progression.

Study design

  • Retrospective cohort of 82 patients with LN studied at the time of biopsy and at 12 and 48 months.
  • Primary outcome was adverse renal outcome (ARO) at 48 months, defined as doubling of serum creatinine, as creatinine >4 mg/dL if initial >2.5 mg/dL, or end-stage renal disease.
  • The receiver operating characteristic (ROC) curves at 48 months were used to predict ARO.
  • Funding: None.

Key results

  • Higher values of serum albumin at 1 year were associated with lower risk for ARO at 48 months (HR, 0.140; 95% CI, 0.071-0.280).
  • The ROC curve at 48 months produced a cutoff of 3.7 g/dL for serum albumin at 1 year, with values above predicting non-ARO and values below predicting ARO.
  • Serum albumin had a sensitivity of 94%, specificity of 87%, positive predictive value of 64%, and negative predictive value of 98%.

Limitations

  • Retrospective, observational design.
  • No control group.

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