Abstract
Kidney biopsy remains the mainstay of Lupus Nephritis (LN) diagnosis and prognostication. The objective of this study is to identify non-invasive biomarkers that closely parallel renal pathology in LN. Previous reports have demonstrated that serum Insulin-like growth factor binding protein 4 (IGFBP-4) was increased in diabetic nephropathy in both animal models and patients. We proceeded to assess if IGFBP4 could be associated with LN. We performed ELISA using the serum of 86 patients with LN. Normal healthy adults (N = 23) and patients with other glomerular diseases (N = 20) served as controls. Compared to the healthy controls or other glomerular disease controls, serum IGFBP-4 levels were significantly higher in the patients with LN. Serum IGFBP-4 did not correlate well with systemic lupus erythematosus disease activity index (SLEDAI), renal SLEDAI or proteinuria, but it did correlate with estimated glomerular filtration rate (R = 0.609, P < 0.0001). Interestingly, in 18 patients with proliferative LN whose blood samples were obtained at the time of renal biopsy, serum IGFBP-4 levels correlated strongly with the chronicity index of renal pathology (R = 0.713, P < 0.001). IGFBP-4 emerges a potential marker of lupus nephritis, reflective of renal pathology chronicity changes.
Highlights
Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder affecting multiple organ systems
As serum Insulin-like growth factor binding protein 4 (IGFBP-4) correlated with Estimated glomerular filtration rate (eGFR) in patients with LN, and since it has been reported that IGFBP-4 is increased in patients with chronic renal failure, [34, 35] we explored if elevated serum IGFBP-4 is indicative of chronic lupus nephritis
Based on an initial array-based screen, serum IGFBP-4 emerged as a potential marker of LN
Summary
Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder affecting multiple organ systems. Even in patients without clinical manifestations of renal disease, and in those with only mild proteinuria, the frequencies of proliferative LN are surprisingly high.[15, 16] nephritic flares are not uncommon in SLE, and are associated with poor prognosis.[17,18,19,20] Nephritic flares may sometimes suggest transformation from one histologic pattern to another.[21] In addition, distinction between a nephritic flare and chronic renal damage could be difficult.[22] a repeat biopsy may be necessary in certain circumstances to guide the decision on immunosuppressive therapy.[21,22,23] Since renal biopsy is invasive and associated with significant risk, there is an urgent need for the identification of non-invasive, surrogate biomarkers that closely parallel renal pathology
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