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Lupus: serum and urine markers of disease activity

In patients with lupus nephritis (LN), soluble tumour necrosis factor receptor 1 (sTNF-R1) could be a useful serum and urine cytokine marker, particularly for the diagnosis of active LN. That is the finding of a new study led by King’s College Hospital, London.

The cross-sectional study recruited 87 patients with systemic lupus erythematosus (SLE) from the Louise Coote Lupus Unit at St Thomas’ Hospital in London.

Serum and urine samples were tested for monocyte chemoattractant protein 1 (MCP-1), regulated upon activation, normal T cell expressed and secreted (RANTES), sTNF-R1, interferon-inducible protein 10 (IP-10), monocyte inhibitory protein 1α and vascular endothelial growth factor (VEGF). Cytokine testing was performed using the FIDIS multiplex bead assay.

The mean level of serum sTNF-R1 was higher in the active LN group compared with both the inactive LN and non-renal SLE groups (P<.001). For urine measurements, there were significant differences between active LN and non-renal SLE for VEGF (P=.016), after statistical correction for multiple testing.

Both urinary and serum sTNF-R1 and IP-10 levels correlated with SLE Disease Activity Index (SLEDAIscores (P<.001), while serum VEGF correlated weakly with SLEDAI (P=.025).

The optimum combination for differentiating active from inactive LN patients was serum VEGF, sTNF-R1, MCP-1 and glomerular filtration rate plus urinary sTNF-R1 and protein-creatinine ratio.

Presenting the findings in the journal Lupus, the authors concluded that the results indicate that for active LN, sTNF-R1 could be a useful serum cytokine marker, with potential for VEGF in the urine.


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