The utility of urinary biomarker panel in predicting renal pathology and treatment response in Chinese lupus nephritis patients

PLoS One. 2020 Oct 27;15(10):e0240942. doi: 10.1371/journal.pone.0240942. eCollection 2020.

Abstract

Given the urgent need for non-invasive biomarkers of LN, we aim to identify novel urinary biomarkers that facilitate diagnosis, assessment of disease activity and prediction of treatment response in a retrospective SLE cohort. A total of 154 SLE patients and 55 healthy controls were enrolled, among whom 73 were active LN patients. We measured renal activity by renal SLEDAI. The treatment response of the active LN patients who finished 6-month induction therapy was assessed based on the American College of Rheumatology response criteria. The expression levels of 10 urinary biomarkers (UBMs): β2-MG, calbindin D, cystatin C, IL-18, KIM-1, MCP-1, nephrin, NGAL, VCAM-1, and VDBP were tested using Luminex high-throughput proteomics technology. All but urinary nephrin levels were significantly increased in active LN compared to healthy controls. uCystatinC, uMCP-1, uKIM-1 levels were significantly higher in active LN group compared to inactive LN group. Correlation analysis revealed positive correlation between uCystatinC, uKIM-1, uMCP-1, uNGAL, uVDBP and RSLEDAI score. In renal pathology, uCystatinC, uKIM-1, uVCAM-1, and uVDBP positively correlated with activity index (AI) while uVCAM-1 positively correlated with chronicity index (CI). Moreover, the combination of uVCAM-1, uCystatinC, uKIM-1 discriminated proliferative LN from membranous LN with an AUC of 0.80 (95%CI: 0.69-0.90). Most importantly, baseline uNGAL demonstrated good prediction ability to discriminate responders from non-responders in active LN patients after 6-month induction therapy. Using a multiplex bead technique, we have identified the combination of uVCAM-1, uCystatinC, uKIM-1 as a biomarker panel to reflect renal pathology and NGAL as a promising urinary biomarker to both reflect disease activity and predict treatment response.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / urine*
  • China
  • Female
  • Gene Expression Regulation
  • Humans
  • Kidney / pathology*
  • Lupus Nephritis / diagnosis*
  • Lupus Nephritis / drug therapy*
  • Lupus Nephritis / pathology
  • Lupus Nephritis / urine
  • Male
  • Middle Aged
  • Proteomics / methods
  • Retrospective Studies
  • Severity of Illness Index
  • Young Adult

Substances

  • Biomarkers

Grants and funding

The study was supported by the National Natural Science Foundation of China (Grant no.: 81771733) received by CB. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.