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Abstract: TH-PO490

Persistent Excretion of Serpin-A3 Indicates Lack of Response to Therapy in Class III and IV Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Martinez-Rojas, Miguel Angel, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Sanchez Navarro, Andrea, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Mejia-Vilet, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico
  • Pérez-Villalva, Rosalba, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
  • Bobadilla, Norma, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
Background

We previously reported that urinary Serpin-A3 excretion (uSerpA3) is significantly elevated in patients with active lupus nephritis (LN). Here, we evaluated the course of uSerpA3 during the 1st-year of treatment and its association with response to therapy in patients with proliferative LN.

Methods

An observational longitudinal study including sixty Mexican adults with proliferative LN followed during the 1st-year after LN-flare. uSerpA3 was detected by Western blot at flare and after 3, 6, and 12-months. Response to therapy was determined 1-year after the LN-flare. We evaluated the correlation between uSerpA3 and histological parameters at LN-flare. The temporal association between uSerpA3 and response to therapy was analyzed with linear mixed models. uSerpA3 prognostic performance for response was evaluated with ROC curves.

Results

Among the 60 patients studied, 21 (35%) were class III and 39 (65%) class IV. The uSerpA3 was higher in class IV than in class III LN (6.98 vs. 2.89 DPI/mg-creatinine, p=0.01). Furthermore, uSerpA3 correlated with the histological activity index (r=0.29, p=0.02). There was a significant association between the temporal course of uSerpA3 and the response to therapy. Responders showed a significant drop in uSerpA3 at 6th-month compared to LN-flare (p<0.001), while non-responders persisted with elevated uSerpA3. Moreover, uSerpA3 was significantly lower at flare in responders compared to non-responders (2.69 vs. 6.98 DPI/mg-creatinine, p<0.05). Furthermore, uSerpA3 was able to identify non-responders since the 3rd-month after LN-flare, (AUC=0.77).

Conclusion

The uSerpA3 is an early indicator of kidney inflammation and predictor of clinical response to therapy in patients with proliferative LN.

Funding

  • Government Support – Non-U.S.