Disease Activity in Pediatric Lupus Nephritis May Possibly Be Monitored with Urine Biomarkers

Researchers have discovered a potential new noninvasive measurement for the management of lupus nephritis in pediatric and young adult patients that may help not only keep track of disease progression but also monitor therapeutic responses.

The study, “Development of a Novel Renal Activity Index of Lupus Nephritis in Children and Young Adults,” was published in the journal Arthritis Care and Research.

Researchers sought to further investigate the possibility of using biomarkers (measures of physiological activity including red blood cell counts, cholesterol levels, and protein concentrations) from patients’ urine in an effort to manage, in a noninvasive manner, the progression of lupus nephritis. There is a rich amount of research literature on the possibility, but unfortunately a successful metric has not been discovered.

The team analyzed laboratory tests and 16 urine biomarkers of 47 children with lupus nephritis who underwent a kidney biopsy. The analysis was conducted using two standard renal activity indexes, NIH-AI and tubulointerstitial activity index (TIAI) as a reference.

After analysis, researchers concluded that there were six urine biomarkers excreted by patients with lupus nephritis predicted disease activity:

• monocyte chemotactic protein 1
• hemopexin
• neutrophil
• gelatinase-associated lipocalin ceruloplasmin
• adiponectin
• kidney injury molecule 1

The detection accuracy was between 71 percent and 85 percent with lupus nephritis damage minimally influenced by what the researchers classify as the renal activity index for lupus (RAIL) accuracy.

These results suggest that renal activity and specific urine biomarkers could potentially be a metric for measuring lupus nephritis, and specifically this index will be able to give clinical markers for the monitoring of the degree of inflammation in lupus nephritis patients.

“If confirmed in ongoing experiments, the RAIL will allow for more effective and personalized monitoring of lupus nephritis and its therapy,” the authors wrote. “The availability of standardized clinical platforms for the combined measurement of the urinary biomarkers will enable the testing of this hypothesis in the near future.

“Future research will need to confirm the most appropriate cutoff scores for the RAIL and also investigate how the combinatorial RAIL urine biomarkers can be used to noninvasively predict response to therapy,” they added.