Urine γ-interferon-inducible protein (IP-10) as a biomarker of histological activity of lupus nephritis

Abstract

Introduction: Conventional markers are not reliable predictors of histological activity of lupus nephritis (LN). We aimed to examine the utility of urine γ-interferon-inducible protein (IP-10) in predicting LN flares, diagnosis of LN, and forecasting treatment response. Methods: SLE patients who fulfilled the ACR 1997 criteria with history of LN were enrolled. Urine IP-10 was measured at least once during routine quarterly visits, at the time of diagnosis of active LN, and monthly during induction therapy for 6 months. Results: There were 65 active LN and 46 inactive LN included. The mean urine IP-10 levels among the active and inactive LN were 2.69 (95%CI 2.53-2.86) and 2.18 (95%CI 1.96-2.39) log copies/mcg total RNA respectively (p-value < 0.0001). Clinicopathological discordance was observed in 9 of 55 (16%) biopsied patients (5 with proliferative LN without proteinuric flare and 4 with nephrotic-range proteinuria from glomerulosclerosis). Urine IP-10 predicted histological activity of LN with 91% accuracy, compared to 84% with proteinuric flare. Within two years, half of the clinically inactive LN patients with positive baseline urine IP-10 developed LN flare, whereas no flares were observed in patients with negative baseline urine IP-10. Urine IP-10 levels were not associated with treatment response at 6 months. Conclusion: Urine IP-10 may reflect histological activity of LN more accurately than conventional markers, especially in patients with clinicopathologic discrepancy. Clinically inactive LN patients with positive urine IP-10 were at a higher risk of developing LN flare.

Competing Interest Statement

Grant funding for research but no other competing interest

Funding Statement

This work was supported by the Thailand Research Fund (grant number MRG6180158); the National Science and Technology Development Agency and the Health Systems Research Institute (grant number FDA-CO-2562-9090-TH).

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

the Research Ethics Review Committee for Research Involving Human Subjects of Chulalongkorn University gave ethical approval for this work IRB No. 178/61

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Data Availability

All data produced in the present study are available upon reasonable request to the authors

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