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제목	Blood in the Sediment, Severity on the Slide: Urine Erythrocyte Burden Predicts ISN/RPS Class in Biopsy-Proven Lupus Nephritis from an Indonesian Tertiary Center
저자	Alif Adlan Zulizar
출판정보	2026; 2026(1):
키워드	lupus nephritis, urine, erythrocytes, biopsy, kidney
초록	Objectives: Urinary red blood cells (RBCs) are an inexpensive, routinely available marker of glomerular injury in lupus nephritis (LN). However, the clinicopathological relationship between urine RBC burden and ISN/RPS biopsy class remains incompletely characterized in routine-care settings, particularly in resource-constrained contexts where early triage signals are valuable. Methods: We conducted a retrospective cross-sectional study of patients with biopsy-proven LN at Kariadi hospital in Indonesia during 2020-2025. Urinary erythrocytes (µ/L) from routine urinalysis obtained closest to biopsy were analyzed as log10(RBC+1) and compared across ISN/RPS classes I–V. Descriptive analyses summarized age, sex, urine protein (mg/dL), serum creatinine (mg/dL), eGFR (CKD-EPI), and biopsy-class prevalence. Group differences were tested using Kruskal–Wallis and Mann–Whitney U tests. Monotonic associations were assessed using Spearman correlation. Results: Fifty-two patients were included (mean age 26.3±13.0 years; 84.6% female). Biopsy class distribution was: class I 5.8%, class II 21.2%, class III 26.9%, class IV 38.5%, and class V 7.7%. Urinary RBC burden differed significantly across classes (Kruskal–Wallis p=0.021). Median urine RBCs increased from class I (13.7 µ/L) and class II (37.3 µ/L) to class III (55.3 µ/L), peaking in class IV (250.0 µ/L); class V showed lower median RBCs (14.0 µ/L). Biopsy class correlated positively with urine RBC burden (Spearman ρ=0.30, p=0.030). Patients with proliferative LN (class III/IV) had higher urine RBCs than non-proliferative classes (median 180.5 vs 16.1 µ/L; p=0.037). Urine RBC burden correlated with serum creatinine (ρ=0.30, p=0.031) and showed a non-significant inverse trend with eGFR (ρ=−0.24, p=0.089), while correlation with urine protein was weak (ρ=0.12, p=0.406). Conclusion: Urinary erythrocyte burden was associated with ISN/RPS biopsy class in LN, with the highest levels observed in class IV and proliferative disease. Quantitative urine RBCs may serve as a pragmatic, low-cost triage signal to prioritize urgent nephrology evaluation and timely kidney biopsy.
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