Predicting decline of kidney function in lupus nephritis using urine biomarkers.
OBJECTIVE
To evaluate candidate biomarkers to predict future renal function decline (RFD) in children and adults with lupus nephritis (LN).


METHODS
At the time of enrollment into prospective observational LN cohort studies liver-type fatty acid binding protein (LFABP), albumin, monocyte chemoattractant protein-1 (MCP-1), uromodulin, transferrin, and hepcidin were measured in urine samples of two cohorts of patients with LN, one followed at a pediatric (cohort-1; n = 28) and one at an adult institution (cohort-2; n = 69). The primary outcome was RFD, defined in cohort-1 as a decrease in estimated glomerular filtration rate (eGFR) of ≥20% and in cohort-2 as a sustained increase of ≥25% in serum creatinine concentration (SCr), both from baseline.


RESULTS
All patients (n = 97) had normal eGFR or SCr at the time of urine collection at baseline. RFD occurred in 29% (8/28) of patients in cohort-1 during a mean follow-up of 6.1 months, and in 30% (21/69) of those in cohort-2 during a mean follow-up of 60 months. Individually, in cohort-1, levels of MCP-1, transferrin, LFABP, and albumin were higher in the RFD group than those who maintained renal function, with statistical significance for LFABP and albumin. In cohort-2 the RFD group also had higher levels of urine MCP-1 and albumin than others. The combination of LFABP, MCP-1, albumin, and transferrin had good predictive accuracy for RFD in both cohorts (area under the ROC curve = 0.77-0.82).


CONCLUSION
The combinatorial urine biomarker LFABP, MCP-1, albumin, and transferrin shows promise as a predictor of renal functional decline in LN, and warrants further investigation.
['Abulaban|K M|KM|', 'Song|H|H|', 'Zhang|X|X|', 'Kimmel|P L|PL|', 'Kusek|J W|JW|', 'Nelson|R G|RG|', 'Feldman|H I|HI|', 'Vasan|R S|RS|', 'Ying|J|J|', 'Mauer|M|M|', 'Nelsestuen|G L|GL|', 'Bennett|M|M|', 'Brunner|H I|HI|', 'Rovin|B H|BH|']
D000293:Adolescent D000328:Adult D015415:Biomarkers D018932:Chemokine CCL2 D002648:Child D003404:Creatinine D005260:Female D005919:Glomerular Filtration Rate D064451:Hepcidins D006801:Humans D007677:Kidney Function Tests D008181:Lupus Nephritis D008297:Male D008875:Middle Aged D011446:Prospective Studies D014168:Transferrin D058949:Uromodulin D055815:Young Adult
lupus nephritis biomarker renal function decline SLE kidney injury