Abstract
IntroductionVascular cell adhesion molecule-1 (VCAM-1) is involved in the progression of glomerular and tubulointerstitial injury in lupus nephritis (LN) and can be easily assessed in urine. The aim of this study was to assess urinary soluble VCAM-1 (uVCAM-1) as a biomarker of disease activity and treatment response in LN.MethodsThis prospective study enrolled 62 patients with class III, IV or V LN diagnosed within the last 3 years and divided them in two groups: with and without active nephritis at the inclusion, each group with 31 patients. At each visit, a urine sample was collected for uVCAM-1 evaluation and the nephritis status was assessed.ResultsMedian uVCAM-1 level was elevated in patients with active compared to inactive LN (P < 0.001). The ROC curve of uVCAM-1 demonstrated an AUC of 0.84 and a cutoff of 47.2 ng/mgCr yielded a good sensitivity (74.2%) and specificity (74.2%) for the diagnosis of active LN. A significant correlation was found between uVCAM-1 level and renal activity scores and traditional biomarkers of LN. The level of uVCAM-1 dropped in patients with active LN who went into remission (P < 0.001), increased in patients who went into activity (P = 0.002) and did not change in patients who remained inactive (P = 0.797). The level of uVCAM-1 peaked during the flare of LN (P < 0.05).ConclusionThe uVCAM-1 is a reliable biomarker that reflects renal disease activity and is useful for monitoring individual patients with lupus nephritis over time.
Highlights
Vascular cell adhesion molecule-1 (VCAM-1) is involved in the progression of glomerular and tubulointerstitial injury in lupus nephritis (LN) and can be assessed in urine
The levels of urinary soluble VCAM-1 (uVCAM-1) dropped significantly in patients with active LN who went into remission and significantly increased in patients who went into activity
A significant correlation was found between uVCAM-1 levels and renal activity scores, C3 and C4 levels, antidsDNA, urine protein-creatinine ratio (UPCR) and hematuria
Summary
Vascular cell adhesion molecule-1 (VCAM-1) is involved in the progression of glomerular and tubulointerstitial injury in lupus nephritis (LN) and can be assessed in urine. Anti-double stranded DNA (anti-dsDNA) and serum complements are other non-invasive biomarkers routinely used to monitoring renal activity in patients with LN [6]. They are not sensitive nor specific enough for detecting ongoing disease activity and early relapse of nephritis [4] and they do not reflect kidney damage nor have prognostic value. Urinary biomarkers are directly excreted by the kidney and are obtained They can differentiate the renal activity of the disease from other organic manifestations more accurately than the serum biomarkers [7]
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