ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP PRSYM
    • 2016 ACR/ARHP Annual Meeting
    • 2015 ACR/ARHP Annual Meeting
    • 2014 ACR/ARHP Annual Meeting
    • 2013 ACR/ARHP Annual Meeting
    • 2012 ACR/ARHP Annual Meeting
    • 2011 ACR/ARHP Annual Meeting
    • 2010 ACR/ARHP Annual Meeting
    • 2009 ACR/ARHP Annual Meeting
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • Register
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 2070

Urinary Biomarker Based “a-RAIL”� Study in Adults with Lupus Nephritis

Gaurav Gulati1, Khalid Abulaban2, Jun Ying3, Huijuan Song4, Xiaolan Zhang5, Qing Ma6, Christopher Haffner6, Kasha Wiley7, Michael Bennett8, Brad H. Rovin4 and Hermine I. Brunner9, 1Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, OH, 2Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 3University of Cincinnati, Cincinnati, OH, 4Ohio State University Medical Center, Columbus, OH, 5Ohio State University, Columbus, OH, 6Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, 7Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 8Division of Nephrology, Cincinnati Children`s Hospital Medical Center, Cincinnati, OH, 9Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: lupus nephritis and systemic lupus erythematosus (SLE), Urinary Biomarkers

  • Tweet
  • Email
  • Print
Save to PDF
Session Information

Date: Monday, November 9, 2015

Session Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment III: Biomarkers

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose:

The present study was aimed at developing an adult Renal Activity In Lupus (A-RAIL) algorithm for Lupus Nephritis (LN) activity assessment using urinary biomarkers (UBMs). A similar index for use in children with LN has been recently proposed.

Methods:

Adult Systemic Lupus Erythematosus (SLE) patients requiring a kidney biopsy as part of their standard care were enrolled. Patient demographics, SLE manifestations, laboratory parameters, renal activity/chronicity measures (R-SLEDAI, SDI-R) and a urine sample were collected at the time of biopsy. One expert read the biopsies in a blinded fashion to report National Institute of Health Activity and Chronicity indices (NIH-AI, NIH-CI). Patients were dichotomized as high activity or not based on the NIH-AI score of 10 as cut-off. UBMs measured included:  kidney injury molecule 1, monocyte chemotactic protein 1, neutrophil gelatinase associated lipocalin, ceruloplasmin, adiponectin, hemopexin, alpha-1-acid glycoprotein, hepcidin, lipocalin-like prostaglandin synthase (L-PGDS), transferrin, vitamin D binding protein, transforming growth factor beta, endothelial protein C receptor, and liver type fatty acid-binding protein 1 using standardized ELISA-based assays (except L-PDGS and transferrin, measured by immune nephelometry). Urinary microalbumin and creatinine levels were measured to normalize for proteinuria in the analysis. Candidate RAIL predictors were firstly selected using univariate analyses, followed by stepwise selection in multiple logistic regression models. An A-RAIL algorithm was developed using the selected UBMs, and predictive accuracy calculated using the area under the Receiver Operating Characteristic (ROC) curve (AUC).

Results:

Of the 75 patients studied (age 32.4 ± 10.1 years), 78.7% were females. Caucasian and African American ethnicities were equally represented (46.7%). Mean NIH-AI and CI scores were 4.57 ± 4.11 and 3.23 ± 2.59 respectively. Renal activity was high in 11 (15%). No significant differences were noted for age, gender, ethnicity, or LN stage or laboratory parameters between the two activity groups, except lower C3 in high activity (p = 0.029). A-RAIL algorithm was studied using 10 significant UBMs and all analyses controlled for NIH-CI. The predictive accuracy of analysis was reported “outstanding” at the optimal score threshold ([AUC = 0.9 (95% CI 0.84 – 1.00]), and was similar when normalized for urinary creatinine or microalbumin [Table 1].

Conclusion:

The A-RAIL algorithm, termed “liquid biopsy for LN” by some, provides an accurate non-invasive assessment of LN activity. Its robustness and clinical usefulness is confirmed by use of various standards of normalization of proteinuria with LN. These results are very similar to the pediatric RAIL developed using six UBMs. This sets foundation for further studies assessing disease progression and response to therapy. 

TABLE 1: Diagnostic Accuracy of A-RAIL Algorithm

Statistic

Adult RAIL Pathway Using 10 UBMs

Using Raw Data

Creatinine Adjusted

Microalbumin Adjusted

AUC (95% CI)

0.92 (0.84 – 1.00)

0.94 (0.88, 0.99)

0.90 (0.83, 0.98)

Sensitivity

90.9%

90.9%

90.9%

Specificity

83.6%

83.6%

78.7%

Positive Likelihood Ratio (LR+)

5.54

5.54

4.27

Negative Likelihood Ratio (LR-)

0.11

0.11

0.12

Logit cut

-1.86

-1.72

-1.83


Disclosure: G. Gulati, None; K. Abulaban, None; J. Ying, None; H. Song, None; X. Zhang, None; Q. Ma, None; C. Haffner, None; K. Wiley, None; M. Bennett, None; B. H. Rovin, Lilly, 5; H. I. Brunner, None.

To cite this abstract in AMA style:

Gulati G, Abulaban K, Ying J, Song H, Zhang X, Ma Q, Haffner C, Wiley K, Bennett M, Rovin BH, Brunner HI. Urinary Biomarker Based “a-RAIL”� Study in Adults with Lupus Nephritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/urinary-biomarker-based-a-rail%ef%bf%bd-study-in-adults-with-lupus-nephritis/. Accessed December 16, 2019.
  • Tweet
  • Email
  • Print
Save to PDF

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/urinary-biomarker-based-a-rail%ef%bf%bd-study-in-adults-with-lupus-nephritis/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

Annual Meeting in Atlanta, Georgia

© COPYRIGHT 2019 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies
loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.