Abstract: TH-OR067

Urine Neutrophil Gelatinase-Associated Lipocalin to Predict Renal Response after Induction Therapy in Active Lupus Nephritis

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Satirapoj, Bancha, Phramongkutklao hospital, Bangkok, Thailand
  • Kitiyakara, Chagriya, Ramathibodi Hospital, Bangkok, Thailand
  • Avihingsanon, Yingyos, King Chulalongkorn Memorial hospital, Chulalongkorn University, Bangkok, Thailand
  • Supasyndh, Ouppatham, Phramongkutklao hospital, Bangkok, Thailand
Background

Tubulointerstitial injury is important to predict the progression of lupus nephritis (LN). Urine neutrophil gelatinase-associated lipocalin (NGAL) has been reported to detect worsening LN disease activity. Thus, urine NGAL may predict renal outcomes among lupus patients.

Methods

We conducted a prospective multi-center study among active LN patients with biopsy-proven. All patients provided urine samples for NGAL measurement by ELISA collected from all patients at baseline and at 6-month follow-up after induction therapy.

Results

In all, 75 active LN patients were enrolled (mean age 31.8±9.9 years, median UPCR 4.8 g/g creatinine level with interquartile range (IQR) 2.5 to 8.4 and mean estimated glomerular filtration rate (GFR) 89.1±36.3 mL/min/1.73 m2). At baseline measurement, median urinary NGAL in complete response, partial response and nonresponse groups was 11.8 (IQR; 6.2, 23.5), 18.9 (IQR; 8.9, 43.1), and 78.9 (IQR; 23.2, 118.4) ng/mL, respectively (P=0.004). Urinary NGAL (ng/mL) correlated positively with proteinuria and correlated negatively with serum complement C3 level. Based on ROC analysis, urinary NGAL (AUC; 0.769, 95%CI 0.603-0.935) outperformed conventional biomarkers (serum creatinine, urine protein, and GFR) in differentiating complete and partial response groups from the nonresponse group. The urine NGAL cutoff value in the ROC curve, 28.07 ng/mL, discriminated nonresponse with 75% sensitivity and 66.7% specificity.

Conclusion

Urine NGAL at baseline performed better than conventional markers in predicting a clinical response to treatment of active LN except serum complement C3 level. It may have the potential to predict poor response after induction therapy.

Funding

  • Other NIH Support