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Urinary TNF-like weak inducer of apoptosis (TWEAK) as a biomarker of lupus nephritis

TNF-ähnlicher schwacher Induktor von Apoptose (TWEAK) im Urin als Biomarker einer Lupusnephritis

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Abstract

Background

Renal involvement in systemic lupus erythematosus (SLE), known as lupus nephritis (LN), is a common and severe complication and a major predictor of poor outcome. Long-term survival in SLE can be improved with early diagnosis and prompt treatment of LN. A number of biochemical markers are currently used to clinically assess disease activity in patients; however, they lack sensitivity and specificity for differentiating renal activity and damage in LN. A reliable clinical biomarker that can forecast LN flare and which could be sequentially followed would help to optimize initiation and escalation of therapy at the time of active or relapsing disease.

Objective

This study was carried out to investigate the value of urinary tumor necrosis factor (TNF)-like weak inducer of apoptosis (uTWEAK) as a biomarker for active lupus nephritis.

Patients and methods

A total of 44 patients with SLE fulfilling the 1997 revised criteria for the classification of SLE as well as 11 age and sex-matched healthy controls were included in this study and subjected to full medical history taking, clinical examination, routine laboratory investigations, measurement of uTWEAK level as well as renal biopsy for patients with active LN.

Results

The uTWEAK levels were significantly higher in SLE patients with active LN compared to those without or with inactive renal disease and normal healthy subjects.

Zusammenfassung

Hintergrund

Eine Nierenbeteiligung bei einem systemischen Lupus erythematodes (SLE), die sog. Lupusnephritis (LN), ist eine häufige und schwere Komplikation sowie ein wichtiger Prädiktor für ein schlechtes Outcome. Das Langzeitüberleben bei SLE kann durch eine frühzeitige Diagnose und unmittelbare Behandlung der LN verbessert werden. Derzeit werden mehrere biochemische Marker verwendet, um die Nierenaktivität und -schädigung bei LN zu differenzieren, jedoch mangelt es hierzu an Sensitivität und Spezifität. Ein verlässlicher klinischer Biomarker, der einen LN-Schub voraussagen und fortlaufend verfolgen könnte, würde bei der Optimierung des Therapiebeginns und der -eskalation zum Zeitpunkt der aktiven oder rezidivierenden Krankheit helfen.

Ziel

Diese Studie wurde durchgeführt, um den Wert des Tumornekrosefaktor(TNF)-ähnlichen schwachen Induktors von Apoptose im Urin („urinary TNF-like weak inducer of apoptosis“, uTWEAK) als Biomarker für eine aktive Lupusnephritis zu untersuchen.

Patienten und Methoden

Insgesamt 44 Patienten mit SLE, die die überarbeiteten Kriterien für die SLE-Klassifikation aus dem Jahr 1997 erfüllten, sowie 11 alters- und geschlechtsgematchte gesunde Kontrollpersonen wurden in diese Studie eingeschlossen und unterzogen sich einer vollständigen Anamnese, einer klinischen Untersuchung, Routine-Laboruntersuchungen, Messungen der uTWEAK-Werte und Patienten mit aktiver LN einer Nierenbiopsie.

Ergebnisse

Die uTWEAK-Werte waren bei SLE-Patienten mit aktiver LN signifikant höher im Vergleich zu den Werten der Patienten ohne oder mit inaktiver Nierenerkrankung sowie der gesunden Kontrollpersonen.

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Notes

  1. Spot urine test is a test for proteinuria. Protein-to-creatinine ratio (P/C) in spot urine specimens is a predictor of urine protein excretion in 24-h collections.

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Authors and Affiliations

  1. Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

    M. N. Salem, H. A. Taha & M. Abd El-Fattah El-Feqi

  2. Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    N. N. Eesa

  3. Clinical Pathology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

    R. A. Mohamed

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  1. M. N. Salem
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  2. H. A. Taha
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Correspondence to M. N. Salem.

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Conflict of interests

H. A. Taha, M. N. Salem, M. Abd El-Fattah El-Feqi, N. N. Eesa and R. A. Mohamed declare that they have no competing interests.

All studies on humans described in this manuscript were carried out with the approval of the responsible ethics committee and in accordance with national and the Helsinki Declaration of 1975 (in its current revised form). Informed consent was obtained from all patients included in the study.

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U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

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Salem, M.N., Taha, H.A., Abd El-Fattah El-Feqi, M. et al. Urinary TNF-like weak inducer of apoptosis (TWEAK) as a biomarker of lupus nephritis. Z Rheumatol 77, 71–77 (2018). https://doi.org/10.1007/s00393-016-0184-1

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