TY - JOUR T1 - Resolution of Proteinuria in Lupus Nephritis: Hurry Up and Wait JF - The Journal of Rheumatology JO - J Rheumatol SP - 622 LP - 625 DO - 10.3899/jrheum.140157 VL - 41 IS - 4 AU - JOANNE M. BARGMAN AU - CARMEN AVILA-CASADO Y1 - 2014/04/01 UR - http://www.jrheum.org/content/41/4/622.abstract N2 - In this issue of The Journal, Touma and colleagues map out the time to improvement or resolution of proteinuria in a historical cohort of patients with lupus nephritis (LN)1. More than 200 patients entered in the University of Toronto Lupus Clinic database and followed between 1970 and 2011 constituted the cohort for this analysis. Regardless of the time from the original diagnosis of lupus, the first identified onset of proteinuria functioned as the baseline for this study. From that point onward, the time it took for recovery of proteinuria was measured. Recovery was defined as a 24 h urine protein of < 0.5 g. If a 24 h urine collection was not available, urine dipstick for albumin, or a random urine protein to creatinine ratio was used. For the Kaplan-Meier analysis of proteinuria over time, the maximum followup was 5.5 years. If a patient still had proteinuria at this time, the data were censored. Interestingly, the mean duration of lupus before the onset of proteinuria was more than 5 years.None of the baseline characteristics, renal or extrarenal, predicted who would recover from proteinuria. Even the subgroup of patients with true nephrotic-range proteinuria had the same degree of ultimate resolution compared to those with subnephrotic protein excretion. Not surprisingly, the greater the proteinuria at baseline, the longer it took for recovery (the further you live from home, the longer it takes to get there). The presence of persistently low complement levels was associated with increased time to recovery, which again makes sense, as it can reflect either more aggressive, treatment-resistant disease or non-adherence to therapy. Biopsy class also did not appear to influence resolution or time to resolution, although it is regrettable that 20 patients with biopsy-proven lupus membranous nephropathy were excluded from analysis because of the … Address correspondence to Dr. Bargman, University Health Network, 200 Elizabeth Street, 8N-840, Toronto, ON CANADA M5G 2C4. E-mail: joanne.bargman{at}uhn.ca ER -