Urine biomarker score captures response to induction therapy with lupus nephritis
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Published:2023-01-30
Issue:8
Volume:38
Page:2679-2688
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ISSN:0931-041X
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Container-title:Pediatric Nephrology
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language:en
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Short-container-title:Pediatr Nephrol
Author:
Cody Ellen M.ORCID, Wenderfer Scott E.ORCID, Sullivan Kathleen E.ORCID, Kim Alfred H. J.ORCID, Figg WesleyORCID, Ghumman HarneetORCID, Qiu Tingting, Huang BinORCID, Devarajan PrasadORCID, Brunner Hermine I.ORCID
Abstract
Abstract
Background
The Renal Activity Index for Lupus (RAIL) consists of urine protein assessment of neutrophil gelatinase–associated lipocalin, kidney injury molecule-1, monocyte chemotactic protein 1, adiponectin, hemopexin, and ceruloplasmin, which non-invasively identifies lupus nephritis (LN). We aimed to delineate RAIL scores with inactive versus active LN and changes over time with response to LN induction therapy.
Methods
There were 128 pediatric patients with systemic lupus erythematosus (SLE) and age-matched healthy controls recruited in a prospective case control study, with kidney biopsy confirmation of LN. Laboratory and clinical information was recorded and urine collected at diagnosis and end of induction and during maintenance therapy. Response to therapy was assessed by repeat kidney biopsy or laboratory parameters. Urine was assayed for RAIL biomarkers and the RAIL score calculated.
Results
Pediatric RAIL (pRAIL) scores from 128 children and young adults with SLE (with/without LN: 70/38) including 25 during LN induction therapy, differentiated clinically active LN from inactive LN or without LN, and controls (all p < 0.0017). pRAIL scores significantly decreased with complete LN remission by 1.07 ± 1.7 (p = 0.03).
Conclusions
The RAIL biomarkers differentiate LN patients based on activity of kidney disease, with decreases of ≥ 1 in pRAIL scores indicating complete response to induction therapy. Significantly lower RAIL scores in healthy controls and in SLE patients without known LN raise the possibility of subclinical kidney disease.
Graphical abstract
Funder
Lupus Foundation of America NIDDK PORTICO Dr. Ralph and Marian Falk Medical Research Trust Center for Clinical and Translational Science, University of Cincinnati P&F Study NIH
Publisher
Springer Science and Business Media LLC
Subject
Nephrology,Pediatrics, Perinatology and Child Health
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