Abstract: FR-PO747

Urine Epidermal Growth Factor, Monocyte Chemoattractant Protein-1, or Their Ratio as Biomarkers for Response to Therapy in Primary Glomerulonephritis

Session Information

Category: Glomerular

  • 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine

Authors

  • Chanrat, Eakkapat, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Not Applicable, Thailand
  • Worawitchawong, Supanat, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Not Applicable, Thailand
  • Sathirapongsasuti, Nuankanya, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Not Applicable, Thailand
  • Kitiyakara, Chagriya, 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 outcomes in primary glomerulonephritis (GN). Elevated urinary MCP-1 and decreased urinary EGF have been associated with renal fibrosis, but there is limited information on their prognostic roles. We evaluated the relationships of urinary EGF, MCP-1 or their ratio at baseline with subsequent response to therapy and renal function at 24 months in patients with primary GN.

Methods

This is a prospective study in primary GN (n=74). Urine samples were collected at the time of biopsy. MCP-1 and EGF were analyzed by ELISA kits and expressed as a ratio to creatinine (ng/mg Cr) or as EGF/MCP-1 (ng/ng). Complete remission (CR) was defined as proteinuria < 0.3 g/gCr and other subjects were categorized as Not in remission (NR). The predictive role of the biomarkers and traditional clinical parameters for CR were analyzed by Cox multivariate regression analysis.

Results

The diagnoses were: IgA nephropathy (n=28), focal segmental glomerulosclerosis (n=16), minimal change disease (n=10) and membranous nephropathy (n=20). Median follow up was 20 (12, 28) months. Estimated glomerular filration rate (eGFR) at baseline correlated with positively with EGF, EGF/MCP-, and inversely with MCP-1. Proteinuria at baseline correlated positively with MCP-1, and inversely with EGF/MCP-1. After treatment with renin-angiotensin blockers and/or immune-modulating agents, 38 patients (51.4%) achieved CR. Baseline EGF and EGF/MCP-1 levels were higher in CR compared to NR, whereas MCP-1 was not different. High EGF (>75 ng/mgCr) at baseline was an independent predictor for subsequent CR (OR (95%CI): 2.86 (1.37-5.94), p=0.005). In the subset of patients (n=43) who completed 24 months follow-up, high baseline EGF (>75 ng/mgCr) had lower proteinuria at 24 months follow-up. Baseline EGF and EGF/MCP-1 correlated positively with eGFR at 24 months.

Conclusion

High urinary EGF at baseline was an independent predictor of subsequent CR. EGF and EGF/MCP-1 at baseline correlated positively with eGFR and inversely with proteinuria at 24 months. Larger studies are necessary to confirm the benefits in the management of primary GN.

Funding

  • Government Support - Non-U.S.