{
  "abstract": "Background The long-term trajectories of estimated glomerular filtration rate (eGFR) and their relation to early proteinuria trajectories in biopsy-proven lupus nephritis (LN) are unclear. We aimed to identify eGFR trajectories and examine their association with 24-hour urine protein (24hUP) trajectories.Methods In this retrospective single-centre cohort, 215 adults with class III/IV (±V) LN were followed from the date of their initial renal biopsy. eGFR and 24hUP trajectories were modelled using latent class trajectory models, and associations with clinical and pathologic features were assessed. Multinomial logistic regression was used to identify baseline predictors of trajectory membership.Results Three eGFR trajectories were identified: stable (87.9%), late-decline (7.0%) and persistent-decline (5.1%). Persistent-decline patients had a higher chronicity index (p<0.01) and baseline serum creatinine (p=0.03), and a higher chronicity index independently predicted persistent-decline (OR 1.64; 95% CI 1.24 to 2.18). The late-decline group had higher baseline eGFR (p=0.03) and more frequent proteinuric flares (91% vs 25% for stable, p<0.01). Three 24hUP trajectories were identified: low-decreasing (81.5%), high-decreasing (11.4%) and high-increasing (7.1%). eGFR late/persistent-decline trajectories were associated with high-decreasing/increasing 24hUP trajectories (p<0.001). Notably, 48% of patients with declining eGFR achieved complete proteinuria response within 12 months, and 38% met criteria for complete renal response, despite long-term eGFR deterioration.Conclusion Distinct long-term trajectories of eGFR and proteinuria exist in LN. Short-term responses in eGFR and proteinuria may not reliably predict long-term renal outcomes, highlighting the need for more robust biomarkers to improve risk stratification and management in LN.",
  "authors": [
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Wei Ning"
    },
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Peng-wu Liang"
    },
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Tong-tao Cao"
    },
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Zhao-han Wen"
    },
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Yu Liu"
    },
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Ke-er Wang"
    },
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Xin-hang Luo"
    },
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Ruo-wen Su"
    },
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China",
        "Laboratory of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Yuan-yuan Qi"
    },
    {
      "affiliations": [
        "Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China",
        "Zhengzhou University, Zhengzhou, Henan, China",
        "Laboratory of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China"
      ],
      "name": "Zhan-zheng Zhao"
    }
  ],
  "title": "Trajectories of long-term eGFR and proteinuria in lupus nephritis: a real-world biopsy-proven cohort study",
  "uid": "0e16d042-1c41-5bc8-a768-6b4fe329d2ba"
}