Assessment of urinary TWEAK levels in Mexican patients with untreated lupus nephritis: An exploratory study

Abstract

Objectives: Urinary levels of TWEAK (uTWEAK) may be correlated with the degree of lupus nephritis (LN) activity. Our objective was to determine the sensitivity and specificity of uTWEAK in Mexican patients with untreated active lupus nephritis. Methods: An exploratory study was performed; four groups of patients were analyzed as follows: 1) patients with systemic lupus erythematosus (SLE) without renal activity (SLE-LN), 2) patients with SLE with renal activity (SLE + LN), 3) patients with other types of glomerulopathy (glomerulonephritis, GMN), 4) and healthy patients (controls). Results: In all, 44 patients, with an average age of 35.9 ± 11.5 years, were evaluated. uTWEAK levels were higher in patients with SLE + LN compared with patients in the other groups: SLE + LN 12.88 ± 8.33, SLE-LN 3.12 ± 2.31, GMN 4.36 ± 2.31 and controls 2.41 ± 1.94 pg/mg Cr (p = 0.007). A total of 72.7% of the cases had renal activity index scores above 12, and 90.9% of the cases had scores of chronicity below 6 points. Receiver Operating Characteristic (ROC) curve analysis revealed that uTWEAK levels above 4.91 pg/mg Cr had a sensitivity of 81% and a specificity of 75% for the diagnosis of renal activity due to lupus, with an area under the curve of 0.876 (95% CI: 0.75–0.99). However, no significant correlation was observed between the levels of uTWEAK and the histological findings specific to the activity and chronicity associated with SLE. Conclusions: Our study revealed that uTWEAK can adequately distinguish renal activity due to lupus, but cannot predict the degree of histological activity in Mexican patients with active lupus nephropathy.

Keywords

• Lupus nephritis
• TWEAK
• Urinary biomarkers