Biomarkers and Lupus Nephritis

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Radin M, Miraglia P, Barinotti A, Fenoglio R, Roccatello D, Sciascia S: Prognostic and Diagnostic Values of Novel Serum and Urine Biomarkers in Lupus Nephritis: A Systematic Review. American Journal of Nephrology DOI 10.1159/000517852

The role and value of novel serum and/or urinary biomarkers in the diagnosis and prognosis evaluation of lupus nephritis continues to be highly uncertain.

This is largely due to the paucity of randomized clinical trials and/or the lack of comparison with standard clinically recommended parameters. An extensive literature has accumulated (mainly observational and retrospective) concerning the utility of such novel biomarkers. Only a few have shown much promise, but none have yet been validated in a prospective controlled clinical trial.

In a systematic review of the published data (between 2015 and 2020), involving 8,872 patients with lupus nephritis, Radin et al. attempted to evaluate the current status of novel urinary and/or serum biomarkers in lupus nephritis. They excluded from consideration those biomarkers (like serum creatinine, proteinuria, anti-nuclear antibodies, or serum complement assays) that have already been incorporated into guideline recommendations.

This analysis, not unexpectedly, revealed a great deal of heterogeneity in subject enrollment and in analytic approaches. No randomized clinical trials were included. A few novel biomarkers showed some promise (MCP-1, VCAM-1, urinary adiponectin, KIM-1). Inconsistencies in the utility of many of the studied biomarkers rendered their value suspect. The role of assays for factors acting on B-cells was limited and uncertain.

This field is rather stagnant, and much work needs to be done before any novel biomarker can be elevated to routine clinical use as standard-of-care. In my opinion, none can yet be used to augment a precision-medicine approach to lupus nephritis. The conclusions of the authors of this detailed systematic review support this viewpoint.

Richard Glassock

Quoted Karger Article

Prognostic and Diagnostic Values of Novel Serum and Urine Biomarkers in Lupus Nephritis: A Systematic Review