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Urinary MCP-1 and TWEAK as non-invasive markers of disease activity and treatment response in patients with lupus nephritis in South Africa

  • Nephrology - Original Paper
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Abstract

Background

Treatment of patients with lupus nephritis (LN) requires judicious use of immunosuppression. Novel biomarkers may be useful for monitoring disease activity and treatment response. We assessed the utility of urinary monocyte chemoattractant protein-1 (uMCP-1) and urinary tumour necrosis factor-like weak inducer of apoptosis (uTWEAK) for disease activity and treatment response monitoring in South Africans with LN.

Methods

We recruited consenting patients with active LN confirmed on kidney biopsy. Urinary levels of MCP-1 and TWEAK were assayed at baseline and after completion of induction therapy using ELISA methods. We also collected relevant demographic, clinical and biochemical data for patients included in this study.

Results

The mean age of patients in this study was 29.8 ± 10.7 years, 60% were patients of mixed ancestry, 70% had proliferative LN and mean spot urine proteinuria at baseline was 0.37 (0.18–0.59) g/mmolCr. At completion of induction therapy, the level of uMCP-1 had reduced to 314.5 (IQR: 197.0–622) pg/mgCr from a baseline of 1092.7 (IQR 578.6–1848) pg/mgCr (P = 0.06) while uTWEAK had reduced to 36.0 (IQR 17.0–88.0) pg/mgCr from 159.0 (IQR: 88.5–295.5) pg/mgCr (P = 0.03). For patients reaching early complete or partial remission (n = 17), both biomarkers had significantly declined in their urine: uMCP-1 (P = 0.018) and uTWEAK (P = 0.015). There was no reduction of both biomarkers in patients not achieving remission and no association between uMCP-1 or uTWEAK with renal histological features.

Conclusion

Our study shows that uMCP-1 and uTWEAK are elevated in patients with active LN, correlated with the remission status (response to treatment) at the end of induction therapy and can, therefore, be useful for monitoring disease activity and treatment response.

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Data availability

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This project was supported by grants from the South African National Research Fund (NRF) (CPRR150703122950).

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa

    Mothusi W. Moloi, Udeme Ekrikpo & Ikechi G. Okpechi

  2. Kidney and Hypertension Research Unit, University of Cape Town Cape Town, Cape Town, South Africa

    Mothusi W. Moloi, Udeme Ekrikpo & Ikechi G. Okpechi

  3. Department of Medicine, University of Botswana, Gaborone, Botswana

    Mothusi W. Moloi

  4. Division of Chemical Pathology, University of Cape Town and National Health Laboratory Services (NHLS), Cape Town, South Africa

    Jody A. Rusch & Fierdoz Omar

  5. Department of Medicine, University of Uyo, Uyo, Nigeria

    Udeme Ekrikpo

  6. Division of Human Genetics, University of Cape Town, Cape Town, South Africa

    Collet Dandara

  7. Department of Medicine, University of Alberta, Edmonton, Canada

    Aminu K. Bello & Ikechi G. Okpechi

  8. Department of Medicine, University of Cambridge, Cambridge, UK

    David Jayne

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Contributions

MWM, JAR, FO, DJ and IGO conceived the study. MWM, JAR, CD and IGO were involved in data collection, MWM, JAR, FO, UE, and IGO were involved in data analysis, writing up and interpretation, all authors were involved in revision of the manuscript for intellectual content. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Ikechi G. Okpechi.

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The authors declare that they have no competing interests.

Ethics approval and consent to participate

Ethics approval was obtained from the University of Cape Town Human Research Ethics Committee (HREC #332/2017). All participating patients provided signed consent form.

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Moloi, M.W., Rusch, J.A., Omar, F. et al. Urinary MCP-1 and TWEAK as non-invasive markers of disease activity and treatment response in patients with lupus nephritis in South Africa. Int Urol Nephrol 53, 1865–1873 (2021). https://doi.org/10.1007/s11255-020-02780-9

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