Urine neutrophil gelatinase-associated lipocalin to predict renal response after induction therapy in active lupus nephritis

• Published in: BMC nephrology Vol. 18; no. 1; pp. 263 - 8
• Main Authors: Satirapoj, Bancha, Kitiyakara, Chagriya, Leelahavanichkul, Asada, Avihingsanon, Yingyos, Supasyndh, Ouppatham
• Format: Journal Article
• Language: English
• Published: London BioMed Central 04.08.2017; BioMed Central Ltd; BMC
• Subjects: Adult; Analysis; Arthritis; Biomarkers; Biomarkers - urine; Biopsy; Blood pressure; Care and treatment; Clinical Research; Complement component C3; Creatinine; Enzyme-linked immunosorbent assay; Enzymes; Female; Follow-Up Studies; Gelatinase; Genetic aspects; Glomerular filtration rate; Health risk assessment; Humans; Induction Chemotherapy - trends; Induction therapy; Internal Medicine; Kidney diseases; Kidneys; Laboratories; Lipocalin; Lipocalin-2 - urine; Lupus; Lupus nephritis; lupus nephritis (LN); Lupus Nephritis - diagnosis; Lupus Nephritis - drug therapy; Lupus Nephritis - urine; Male; Medicine; Medicine & Public Health; Mortality; Nephritis; Nephrology; Neutrophil gelatinase-associated lipocalin (NGAL); Neutrophils; Patients; Physiological aspects; Predictive Value of Tests; Prognosis; Prospective Studies; Proteins; Proteinuria; Research Article; Rheumatology; ROC curve; Rodents; Statistical analysis; systemic lupus erythematosus (SLE); Transport proteins; Urine; Young Adult; Thailand; systemic lupus erythematosus (SLE); ROC curve; Neutrophil gelatinase-associated lipocalin (NGAL); lupus nephritis (LN)
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-017-0678-3

Background Tubulointerstitial injury is important to predict the progression of lupus nephritis (LN). Urine neutrophil gelatinase-associated lipocalin (NGAL) has been reported to detect worsening LN disease activity. Thus, urine NGAL may predict renal outcomes among lupus patients. Methods We conducted a prospective multi-center study among active LN patients with biopsy-proven. All patients provided urine samples for NGAL measurement by ELISA collected from all patients at baseline and at 6-month follow-up after induction therapy. Results In all, 68 active LN patients were enrolled (mean age 31.7 ± 10.0 years, median UPCR 4.8 g/g creatinine level with interquartile range (IQR) 2.5 to 6.9 and mean estimated glomerular filtration rate (GFR) 89.6 ± 33.7 mL/min/1.73 m 2 ). At baseline measurement, median urinary NGAL in complete response, partial response and nonresponse groups was 10.86 (IQR; 6.16, 22.4), 19.91 (IQR; 9.05, 41.91) and 65.5 (IQR; 18.3, 103) ng/mL, respectively ( p  = 0.006). Urinary NGAL (ng/mL) correlated positively with proteinuria and blood pressure, and correlated negatively with serum complement C3 level and estimated GFR. Based on ROC analysis, urinary NGAL (AUC; 0.724, 95%CI 0.491–0.957) outperformed conventional biomarkers (serum creatinine, urine protein, and GFR) in differentiating complete and partial response groups from the nonresponse group. The urine NGAL cut-off value in the ROC curve, 28.08 ng/mL, discriminated nonresponse with 72.7% sensitivity and 68.4% specificity. Conclusion Urine NGAL at baseline performed better than conventional markers in predicting a clinical response to treatment of active LN except serum complement C3 level. It may have the potential to predict poor response after induction therapy.