Abstract: FR-PO730

Urine Epidermal Growth Factor, Monocyte Chemoattractant Protein-1, or Their Ratio in Lupus Nephritis: Relationship with Renal Histology and Response to Therapy

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Kitiyakara, Chagriya, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Not Applicable, Thailand
  • Ngamjanyaporn, Pintip, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Not Applicable, Thailand
  • Worawichawong, Suchin, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Not Applicable, Thailand
  • Khiewngam, Khantong, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Not Applicable, Thailand
  • Radinahamed, Piyanuch, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Not Applicable, Thailand
Background

The balance between pro-inflammatory cytokines such as monocyte chemoattractant protein- 1 (MCP-1) and protective cytokines such as epidermal growth factor (EGF) likely determines the disease activity and outcomes in glomerular diseases, but there is limited data in lupus nephritis (LN). In this study, we evaluated the relationship between urinary EGF, MCP-1 or their ratio at baseline with renal histology and the response to immunosuppressive therapy at 6 months follow-up.

Methods

This is a prospective study of biopsy-proven LN (n = 69). Urine samples were collected at biopsy. MCP-1 and EGF were analyzed by ELISA. Response to treatment was defined as 50% or greater reduction in proteinuria or proteinuria <0.5g/g Cr. Biomarker levels were compared between histological categories. Factors associated with treatment response at 6 months were analyzed by multivariate logistic regression in LN Classes III-IV.

Results

LN Classes were: II, III, IV, V, VI (n=9, 25, 21, 13,1). Compared to Class II, patients with Class III-V had higher MCP-1 and lower EGF/MCP-1 whereas EGF was not different. High MCP-1was independently associated with Class III-V. Patients with high activity index (AI ≥7) had higher MCP-1 and lower EGF/MCP-1 compared to patients with low AI. Patients with high chronicity index (CI≧3) had lower EGF/MCP-1 compared to patients with low CI. MCP-1 was higher in patients with wireloop, karryorhexis, tubulitis, tubular atrophy, interstitial fibrosis and EGF/MCP1 was lower in patients with PMN infiltration, wireloop, karryorhexis and cellular infiltration compared to patients without these features. In Class III-IV patients with 6 months follow-up (n= 41), 36 responded to immunosuppression and 27 were non-responders (NR). EGF was higher in Responders [EGF (ng/mg Cr): Responders: 141 (74, 283) vs NR: 57 (24, 87), p=0.025] whereas MCP-1 or EGF/MCP-1 were not different. EGF (per ng/ mg Creatinine) was independently associated with response to immunosuppression [OR (95%CI): 1.02 (1.00-1.034), p=0.034.]

Conclusion

Overall, MCP-1 was higher in LN with adverse histopathological features. Among Class III-IV patients, the response to immunosuppressive therapy at 6 months was independently associated with low baseline EGF, but not high MCP-1.

Funding

  • Government Support - Non-U.S.