Urinary neutrophil gelatinase-associated lipocalin as a novel biomarker for disease activity in lupus nephritis.

Tamar Rubinstein, Milena Pitashny, Benjamin Levine, Noa Schwartz, Julie Schwartzman, Elena Weinstein, Jose M. Pego-Reigosa, Tim Y T Lu, David Isenberg, Anisur Rahman, Chaim Putterman

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Abstract

Clinical and laboratory markers in current use have limited specificity and sensitivity for predicting the development of renal disease in lupus patients. In this longitudinal study, we investigated whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) predicts active nephritis and renal flares in lupus patients with and without a history of biopsy-proven lupus nephritis. Renal disease activity and flare status was determined by SLEDAI and BILAG scores. Random effects models were used to determine whether uNGAL was a significant predictor for renal disease activity in SLE patients, and for renal flares in patients with established nephritis. To assess the predictive performance of uNGAL, receiver operating characteristic (ROC) curves were constructed using the previous visit's uNGAL level. These curves were then compared with curves constructed with currently used biomarkers. Cut-offs determined by ROC curves were tested in an independent validation cohort. uNGAL was found to be a significant predictor of renal disease activity in all SLE patients, and a significant predictor for flare in patients with a history of biopsy-proven nephritis, in multivariate models adjusting for age, race, sex and anti-double-stranded (ds)DNA antibody titres. As a predictor of renal flare in patients with biopsy-proven nephritis, uNGAL outperformed anti-dsDNA antibody titres. These results were confirmed in an independent validation cohort. uNGAL predicts renal flare in patients with a history of biopsy-proven nephritis with high sensitivity and specificity. Furthermore, uNGAL is a more sensitive and specific forecaster of renal flare in patients with a history of lupus nephritis than anti-dsDNA antibody titres.

Original languageEnglish (US)
Pages (from-to)960-971
Number of pages12
JournalRheumatology (Oxford, England)
Volume49
Issue number5
StatePublished - May 2010

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Lupus Nephritis
Biomarkers
Kidney
Nephritis
Biopsy
ROC Curve
Anti-Idiotypic Antibodies
Lipocalin-2
Sensitivity and Specificity
Longitudinal Studies
Antibodies
DNA

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Urinary neutrophil gelatinase-associated lipocalin as a novel biomarker for disease activity in lupus nephritis. / Rubinstein, Tamar; Pitashny, Milena; Levine, Benjamin; Schwartz, Noa; Schwartzman, Julie; Weinstein, Elena; Pego-Reigosa, Jose M.; Lu, Tim Y T; Isenberg, David; Rahman, Anisur; Putterman, Chaim.

In: Rheumatology (Oxford, England), Vol. 49, No. 5, 05.2010, p. 960-971.

Research output: Contribution to journalArticle

Rubinstein, T, Pitashny, M, Levine, B, Schwartz, N, Schwartzman, J, Weinstein, E, Pego-Reigosa, JM, Lu, TYT, Isenberg, D, Rahman, A & Putterman, C 2010, 'Urinary neutrophil gelatinase-associated lipocalin as a novel biomarker for disease activity in lupus nephritis.', Rheumatology (Oxford, England), vol. 49, no. 5, pp. 960-971.
Rubinstein, Tamar ; Pitashny, Milena ; Levine, Benjamin ; Schwartz, Noa ; Schwartzman, Julie ; Weinstein, Elena ; Pego-Reigosa, Jose M. ; Lu, Tim Y T ; Isenberg, David ; Rahman, Anisur ; Putterman, Chaim. / Urinary neutrophil gelatinase-associated lipocalin as a novel biomarker for disease activity in lupus nephritis. In: Rheumatology (Oxford, England). 2010 ; Vol. 49, No. 5. pp. 960-971.
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