Background/Purpose: Up to 60% of SLE patients develop renal involvement, and renal injury is an important predictor of mortality in patients with SLE. Kidney biopsy is the gold standard for diagnosis of active lupus nephritis (LN), and active LN is associated with proteinuria, active urinary sediment and/or a rise in serum creatinine. Urine protein/creatinine ratio is often used to monitor LN activity over time, and proteinuria is accepted as the most effective predictor of the long-term outcome of LN. However, none of these measures has proved sufficient for identification and analysis of the biologic events that underlie the development of active LN. We analyzed extensive laboratory and clinical data and blood gene expression data in relation to urine protein to identify an informative measure of LN activity over time.

Conclusion: Proteinuria is an indicator of worsening LN. However, its usefulness as a marker is limited by concurrent urinary tract infections, circadian rhythms, oliguria and other factors. Through study of a longitudinal series of LN samples we demonstrate that serum albumin levels negatively correlate with classical measures of renal involvement, including proteinuria, URBC, and UWBC and might herald a renal flare. Moreover, serum albumin levels identified gene transcripts in blood that may reflect significant molecular mechanisms that contribute to LN flare, allowing novel insights into the pathogenesis of LN.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/identification-of-a-serum-measure-of-lupus-nephritis-activity-that-detects-molecular-pathways-and-mechanisms-implicated-in-renal-damage/