Abstract
BackgroundThe information concerning non-invasive, easily obtainable, and accurate biomarkers for diagnosis of lupus nephritis (LN) is extremely limited. The aim of this study was to evaluate the diagnostic performance of cystatin C (CysC) and complement component 1q (C1q) for LN.MethodsA case-control study that included 905 patients with systemic lupus erythematosus (SLE) without LN (group SLE), 334 patients with active lupus nephritis (group LNA), 255 patients with inactive lupus nephritis (group LNI), and 497 healthy individuals (group HC) was performed in Mianyang Central Hospital from March 2017 to December 2018. The serum levels of CysC, C1q, urea (Urea), and creatinine (Creat) were measured, and 2 estimated glomerular filtration rates (eGFRCysC and eGFRCreat) were calculated by equations which were based on serum CysC established by our group and the modification of diet in renal disease (MDRD), respectively. ANOVA analysis or Kruskal-Wallis test was used for comparing the differences among the groups, and receiver operating characteristic (ROC) curve was applied to identify the diagnostic efficiencies of individual or combined multiple indicators.ResultsSignificantly elevated CysC and decreased C1q were observed in the LNA and LNI groups, which was in contrast to their levels in the SLE and HC groups. CysC (AUC = 0.906) or eGFRCysC (AUC = 0.907) assessed the highest diagnostic performance on LNA when detected individually, followed by C1q (AUC = 0.753). Joint utilization of C1q and CysC achieved very good performance (AUC = 0.933) which approximated to the best one observed in the combinations of C1q, Urea, CysC, eGFRCreat, and Creat (AUC = 0.975).ConclusionThe separately detected CysC (eGFRCysC) and C1q were superior to the conventional biomarkers Urea, Creat, and eGFRCreat in the diagnosis of LNA. Moreover, although the combined detection of Urea, Creat, C1q, CysC, and eGFRCreat had the greatest diagnostic performance, the joint utilization of CysC and C1q could be prioritized for rapid discrimination of LNA if the economic burden is taken into consideration.
Highlights
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by the involvement of diverse autoantibodies
A total number of 1494 patients were recruited, including 125 men and 1369 women with a mean age of 39.2 ± 12.8 years. These patients were further divided into 3 groups: 905 SLE patients without renal involvement, 334 patients with active lupus nephritis, and 255 patients with inactive lupus nephritis
Our study revealed that cystatin C (CysC)/eGFRCysC and component 1q (C1q) could be promising biomarkers for the identification of LNA in SLE patients, some limitations have to be acknowledged
Summary
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by the involvement of diverse autoantibodies. When the kidney is involved, this condition can lead to lupus nephritis (LN) [2, 3]. LN was found to occur in 15–30% of the patients with lupus at the time of initial diagnosis and Accurate diagnosis and active treatment can preserve the kidney function of LN patients and delay the process of kidney fibrosis, postponing the occurrence and development of end-stage kidney disease [2]. A few lupus nephritis management guidelines have been published currently, they have been established in the USA and European countries, or are internationally based [6]. The information concerning non-invasive, obtainable, and accurate biomarkers for diagnosis of lupus nephritis (LN) is extremely limited. The aim of this study was to evaluate the diagnostic performance of cystatin C (CysC) and complement component 1q (C1q) for LN
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