Urinary cellular biomarkers as an early diagnostic test for treatment of active lupus nephritis compare with kidney biopsy guided therapy

Abstract

Background: Both patient and renal survival in lupus nephritis depend mainly on treatment response. Early management increase remission rate and improve renal survival. Objective: To demonstrate the better renal remission by the early non-invasive biomarkers testing compared to the conventional approach. Material and method: patients who met proteinuric or nephritic flare criteria were recruited. Biomarker group (N=14) used urine IP-10 to guide treatment. Induction immunosuppression was initiated without waiting for renal pathology. Whereas in the historical cohort (conventional group, N=26) induction therapy was initiated based on renal biopsy results. Primary outcome was overall renal remission. Secondary outcomes were time to remission, adverse event and immunosuppressive dosage Results: The HR of overall renal remission in biomarker group compared to conventional group was 1.23 (95% 0.57-2.67; P=0.595). The mean steroid dosage was 13.1±6.8 vs. 20.7±9.1 P=0.015 and the median time from renal flare to renal remission was 16 weeks (95%CI 9.89-22.1 weeks) vs. 25 weeks (95% CI 13.8-36.2 weeks) in biomarker arm vs. conventional arm respectively. Conclusion: Using urinary IP-10 as LN biomarker couldn’t show better overall renal remission, but can shorten time from renal flare to renal response and decrease net prednisolone dosage. Further larger study is needed to confirm this results.