Potential biomarkers of pediatric lupus nephritis identified
medwireNews: Levels of three proteins in the urine are significantly elevated among children with lupus nephritis compared with healthy controls, results of an interim analysis of a multicenter study suggest.
“Urinary biomarkers that reflect [lupus nephritis] activity and have prognostic value are much needed to guide the judicious use of immunosuppressive drugs in these patients,” said Patrícia Costa Reis, from the Children’s Hospital of Philadelphia in Pennsylvania, USA, and study co-authors in a poster presentation at the Annual European Congress of Rheumatology (EULAR) 2017 in Madrid, Spain.
While renal histology is used for the diagnosis of lupus nephritis, it is “seldom repeated for monitoring due to its invasiveness,” they added.
The researchers found that average levels of human epidermal growth factor receptor 2 (HER2) were approximately 500 pg/mL among 91 children with biopsy-confirmed lupus nephritis, compared with approximately 250 pg/mL among 40 age- and gender-matched children without kidney disease, a significant difference.
Similarly, levels of urinary TWEAK were approximately 500 pg per mL in lupus nephritis patients compared with 200 pg/mL among those in the control group, and the corresponding levels of VCAM were 12,000 versus 5000 pg/mL.
The researchers also observed that levels of HER2 and VCAM, but not TWEAK, were significantly elevated during the occurrence of flares compared with periods of remission among the children with lupus nephritis.
The average age of pediatric patients was 15 years, 82.5% were female, and the majority (96.4%) were receiving treatment with hydroxychloroquine.
In an additional analysis of 126 adult patients with lupus nephritis and 23 controls, Costa Reis and colleagues found significantly elevated levels of urinary HER2 among those with lupus nephritis, with measurements of approximately 450 versus 100 pg/mL.
"This study establishes strong foundations for the use of urinary HER2, VCAM and TWEAK as markers of lupus nephritis activity," Costa Reis told medwireNews.
And she added: "It is an ongoing prospective study, so we hope to gather new data to clarify if these markers can predict a flare and response to treatment.
"Finally, this work and our previous translational study of HER2 in lupus nephritis open the door to the analysis of anti-HER2 drugs for the treatment of lupus nephritis."
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