Urinary Activated Leukocyte Cell Adhesion Molecule (ALCAM) as a novel biomarker of lupus nephritis histology

Urinary Activated Leukocyte Cell Adhesion Molecule (ALCAM) as a novel biomarker of lupus nephritis histology

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Background

Lupus nephritis (LN) is one of the most severe complications of SLE patients. We aim to validate urinary Activated Leukocyte Cell Adhesion Molecule (ALCAM) as a biomarker in predicting renal disease histopathology in a Chinese lupus cohort.

Methods

In this cross-sectional study, a total of 256 patients and controls were recruited. A total of 96 biopsy-proven active LN, 59 active SLE without LN, 10 inactive LN patients, 63 inactive SLE patients without renal involvement, and 28 age- and gender-matched healthy controls were recruited(Table 1). Urinary levels of ALCAM were determined by ELISA. Renal histopathology was reviewed by an experienced renal pathologist.

Results

Urinary ALCAM levels were signicantly increased in active LN patients when compared to active SLE patients without renal involvement (p < 0.001), inactive LN patients (p = 0.023), inactive SLE patients without renal involvement (p < 0.001), and healthy controls.

Correlation analysis revealed a positive correlation between urinary ALCAM and general disease activity—SLEDAI score (r = 0.487, p < 0.001), as well as renal disease activity—rSLEDAI (r = 0.552, p < 0.001) and SLICC S (r = 0.584, p < 0.001). Urinary ALCAM also correlated with lab parameters including 24-h urine protein, hemoglobin, and complement 3. Moreover, urinary ALCAM levels were signicantly increased in class III and IV (proliferative) LN as compared to those in class V (membranous) LN. It outperformed conventional biomarkers (anti-dsDNA antibody, C3, C4, proteinuria) in discriminating the two groups of LN.

Conclusion

In summary, our observations indicate that urinary ALCAM is a potential non-invasive biomarker of renal histopathology in LN patients. Urinary ALCAM showed the ability to discriminate class III/IV from V lupus nephritis. It outperformed conventional markers in distinguishing class III/IV ± V from pure class V LN. Urinary ALCAM is reective of renal pathology activity index in lupus nephritis.

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