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Lupus Nephritis

Is renal biopsy still the gold standard for diagnosing lupus nephritis?

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A new study examines the prognostic and diagnostic role of non-invasive biomarkers

From 2015-2020, 85 studies on the diagnostic and prognostic value of urinary and/or serological biomarkers in patients with LN were included and analyzed. Overall, studies included 13,496 patients with systemic lupus erythematosus (SLE); 8872 patients with LN; 487 pediatric patients with LN; 3977 patients with SLE but no LN; 160 pediatric patients with SLE but no LN; and 7679 controls.

Cross-sectional studies accounted for 73% of those included and prospective studies accounted for 17%. Most studies (71%) used biopsy to confirm the diagnosis of LN. Serological biomarkers were investigated in 52% of studies, urinary biomarkers in 34%, and the presence of both in 14%.

Although the systemic lupus erythematosus disease activity index was used in 60% of studies, outcome measures to assess the clinical utility of the biomarkers varied.

The authors noted that despite the heterogeneity, biomarkers, such as urinary monocyte chemoattractant protein, urinary adiponectin, and urinary vascular cell adhesion protein 1, have shown promising results.

“With the kidney biopsy still representing the gold standard, future efforts should focus on harmonizing study inclusion criteria and outcomes, particularly in clinical trials, in order to improve comparability and facilitate the implementations of available biomarkers into the daily practice,” the authors concluded.

Radin M, Miraglia P, Barinotti A, et al. Prognostic and Diagnostic Values of Novel Serum and Urine Biomarkers in Lupus Nephritis: A Systematic Review. Am J Nephrol. 2021;52(7):559-571. doi: 10.1159/000517852. Epub ahead of print. PMID: 34515043.