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Abstract: PO1732

Urinary Biomarkers as a Tool for Monitoring Remissions and Predicting Relapses in Autoimmune Glomerulonephritis

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation


  • Genest, Suzanne Dominique, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Khalili, Myriam, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Rioux, Jean-Philippe, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Quadri, Jérémy, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
  • Bonnefoy, Arnaud, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
  • Troyanov, Stephan, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada

Complement-mediated injury, inflammation and fibrosis play central roles in the pathogenesis of autoimmune glomerulonephritis. The use of urinary biomarkers as a surrogate of these pathways of injury could assist clinicians during the clinical follow-up. We investigated the value of urinary biomarkers of complement activation, inflammation and fibrosis during periods of sustained remission among patients with autoimmune glomerulonephritis.


We prospectively examined 100 patients with ANCA-associated vasculitis, focal segmental glomerulosclerosis, IgA nephropathy, lupus nephritis, membranoproliferative glomerulonephritis and membranous nephropathy. Proteinuria, urinary sC5b-9, monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor-β1 (TGF-β1), expressed as creatinine ratios, were measured at presentation and during follow-up visits. We used standard definitions of remission and relapse for each type of glomerulonephritis. Wilcoxon signed-rank test was used to compare changes in urinary biomarkers during remissions and relapses.


We identified 95 periods of active disease and 82 episodes of sustained remission. Inactive periods lasted a median of 22 (11-32) months. Eighty percent (n=66) of these were not followed by a relapse. During these episodes of remission, urinary biomarkers continued to steadily decrease, achieving a reduction of 40% for proteinuria, 40% for urinary sC5b-9, 38% for MCP-1 and 40% for TGF-β1 (all p < 0.05). Twenty percent (n=16) of inactive periods reflected remissions with subsequent relapses. Biomarker levels during the inactive period preceding relapses did not significantly change for proteinuria (+8%), urinary sC5b-9 (+15%) and MCP-1 (4%), while they decreased for TGF-β1 (-30%, p=0.02). During relapses, we observed a 3.2-fold (1.9-8.3) increase in proteinuria and a significantly greater 8.5-fold (4.2-56.9) increase in urinary sC5b-9 (p=0.001). By contrast, urinary MCP-1 and TGF-β1 increased significantly less than proteinuria.


Failure to achieve a sustained reduction in urinary biomarkers during remission was associated with a subsequent risk of relapse of autoimmune glomerulonephritis. Urinary sC5b-9 appears to be a more discerning marker of immunological relapse.


  • Private Foundation Support