Growing international evidence for urinary biomarker panels identifying lupus nephritis in children - verification within the South African Paediatric Lupus Cohort

Lupus. 2018 Dec;27(14):2190-2199. doi: 10.1177/0961203318808376. Epub 2018 Oct 22.


Background: A urinary biomarker panel including alpha-1-acid-glycoprotein (AGP), lipocalin-like-prostaglandin-D-synthase (LPGDS), transferrin and ceruloplasmin demonstrates an 'excellent' ability for identifying active lupus nephritis in UK/US children. This study aimed to assess whether this panel identifies active lupus nephritis within the South African Paediatric Lupus Cohort.

Methods: Juvenile-onset-systemic lupus erythematosus (JSLE) patients aged < 19 years at diagnosis and healthy controls were recruited. Patients were categorized as having active lupus nephritis (renal BILAG score; A/B and previous histological confirmation) or inactive lupus nephritis (renal BILAG score: D/E). Urinary biomarkers were quantified by ELISA. Mann-Whitney U-test compared biomarker levels between groups. Binary logistic regression and receiver operating curve analysis assessed biomarker combinations.

Results: Twenty-three juvenile-onset-systemic lupus erythematosus patients were recruited with a median age of 13.5 years (interquartile range (IQR) 12.7-14.9) and disease duration of 2.6 years (IQR 1.8-4.0). Eighteen healthy controls had a median age of 11.0 years (IQR 10.0-12.0). AGP, LPGDS, transferrin, ceruloplasmin and VCAM-1 were significantly higher in active than in inactive lupus nephritis patients (corrected p-values, all pc < 0.05), with no difference between inactive lupus nephritis patients and healthy controls (all pc = 1.0). The optimal biomarker combination included AGP, ceruloplasmin, LPGDS and transferrin (area under the curve = 1.0).

Conclusions: A urinary biomarker panel comprising AGP, ceruloplasmin, LPGDS and transferrin previously validated within UK/US cohorts also performed excellently within a racially distinct South African cohort which displayed more severe lupus nephritis.

Keywords: Africa; BILAG; Lupus nephritis; systemic lupus erythematosus; urine biomarkers.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Age of Onset
  • Biomarkers / urine*
  • Case-Control Studies
  • Ceruloplasmin / urine
  • Child
  • Cohort Studies
  • Female
  • Humans
  • Intramolecular Oxidoreductases / urine
  • Lipocalins / urine
  • Logistic Models
  • Lupus Nephritis / diagnosis*
  • Lupus Nephritis / urine*
  • Male
  • Orosomucoid / urine
  • South Africa
  • Transferrin / urine
  • Vascular Cell Adhesion Molecule-1 / urine


  • Biomarkers
  • Lipocalins
  • Orosomucoid
  • Transferrin
  • Vascular Cell Adhesion Molecule-1
  • Ceruloplasmin
  • Intramolecular Oxidoreductases
  • prostaglandin R2 D-isomerase