Urinary soluble VCAM-1 is a useful biomarker of disease activity and treatment response in lupus nephritis
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BMC Rheumatology
RESEARCH ARTICLE
Open Access
Urinary soluble VCAM-1 is a useful biomarker of disease activity and treatment response in lupus nephritis Andrese Aline Gasparin1* , Nicole Pamplona Bueno de Andrade1, Vanessa Hax1, Penélope Esther Palominos1, Marina Siebert2, Romulo Marx1, Pedro Guilherme Schaefer3, Francisco Veríssimo Veronese4 and Odirlei André Monticielo1
Abstract Introduction: Vascular 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. Methods: This 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. Results: Median 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). Conclusion: The uVCAM-1 is a reliable biomarker that reflects renal disease activity and is useful for monitoring individual patients with lupus nephritis over time. Keywords: Lupus nephritis, VCAM-1, Vascular cell adhesion molecule-1, Urinary biomarker
Introduction Kidney involvement occurs in up to 60% of patients with systemic lupus erythematosus (SLE) [1] and is a major predictor of morbidity and mortality [2]. There are different histological subtypes of lupus nephritis (LN) and the treatment changes according to its subtype [3]. Clinical presentation, qualitative urine analysis, renal * Correspondence: [email protected] 1 Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Bairro Santa Cecília, Porto Alegre, RS CEP 90035-903, Brazil Full list of author information is available at the end of the article
function estimation and urine protein-creatinine ratio (UPCR) may suggest a specific subtype of LN and are currently used to assess treatment response as well as to detect nephritic flares [4]. However, they lack sensitivity and specificity for distinguishing renal inflammation and damage, or predicting flare-ups of nephritis [4]. Renal damage occurs before the alteration of these parameters, which l
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