title: Predicting decline of kidney function in lupus nephritis using urine biomarkers.
abstract: OBJECTIVE
  To evaluate candidate biomarkers to predict future renal function decline (RFD) in children and adults with lupus nephritis (LN).
  
  
  METHODS
  At the time of enrollment into prospective observational LN cohort studies liver-type fatty acid binding protein (LFABP), albumin, monocyte chemoattractant protein-1 (MCP-1), uromodulin, transferrin, and hepcidin were measured in urine samples of two cohorts of patients with LN, one followed at a pediatric (cohort-1; n = 28) and one at an adult institution (cohort-2; n = 69). The primary outcome was RFD, defined in cohort-1 as a decrease in estimated glomerular filtration rate (eGFR) of ≥20% and in cohort-2 as a sustained increase of ≥25% in serum creatinine concentration (SCr), both from baseline.
  
  
  RESULTS
  All patients (n = 97) had normal eGFR or SCr at the time of urine collection at baseline. RFD occurred in 29% (8/28) of patients in cohort-1 during a mean follow-up of 6.1 months, and in 30% (21/69) of those in cohort-2 during a mean follow-up of 60 months. Individually, in cohort-1, levels of MCP-1, transferrin, LFABP, and albumin were higher in the RFD group than those who maintained renal function, with statistical significance for LFABP and albumin. In cohort-2 the RFD group also had higher levels of urine MCP-1 and albumin than others. The combination of LFABP, MCP-1, albumin, and transferrin had good predictive accuracy for RFD in both cohorts (area under the ROC curve = 0.77-0.82).
  
  
  CONCLUSIONS
  The combinatorial urine biomarker LFABP, MCP-1, albumin, and transferrin shows promise as a predictor of renal functional decline in LN, and warrants further investigation.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA Department of Pediatrics, Helen DeVos Childrens Hospital, Michigan State University, Grand Rapids, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Abulaban
authors.affiliation: Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, USA.
authors.forename: H
authors.initials: H
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, USA.
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
authors.forename: P L
authors.initials: PL
authors.lastname: Kimmel
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
authors.forename: J W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Nelson
authors.affiliation: Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA.
authors.forename: H I
authors.initials: HI
authors.lastname: Feldman
authors.affiliation: Preventive Medicine and Cardiology Sections, and Department of Medicine, Boston University School of Medicine, Boston, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: Department of Environmental Health, University of Cincinnati, Cincinnati, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ying
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, USA.
authors.forename: M
authors.initials: M
authors.lastname: Mauer
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Nelsestuen
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bennett
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
authors.forename: H I
authors.initials: HI
authors.lastname: Brunner
authors.affiliation: Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, USA Brad.Rovin@osumc.edu.
authors.forename: B H
authors.initials: BH
authors.lastname: Rovin
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000652:urine; D018932:Chemokine CCL2 / Q000652:urine; D002648:Child; D003404:Creatinine / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D064451:Hepcidins / Q000652:urine; D006801:Humans; D007677:Kidney Function Tests; D008181:Lupus Nephritis / Q000175:diagnosis / Q000503:physiopathology* / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014168:Transferrin / Q000652:urine; D058949:Uromodulin / Q000652:urine; D055815:Young Adult
chemical_list: D015415:Biomarkers; C111835:CCL2 protein, human; D018932:Chemokine CCL2; D064451:Hepcidins; D014168:Transferrin; C548612:UMOD protein, human; D058949:Uromodulin; D003404:Creatinine
keywords: SLE; biomarker; kidney injury; lupus nephritis; renal function decline