Urine Monocyte Chemoattractant Protein-1 and Lupus Nephritis Disease Activity: Preliminary Report of a Prospective Longitudinal Study.

Objective. This longitudinal study aimed to determine the urine monocyte chemoattractant protein-1 (uMCP-1) levels in patients with biopsy-proven lupus nephritis (LN) at various stages of renal disease activity and to compare them to current standard markers. Methods. Patients with LN-active or inactive-had their uMCP-1 levels and standard disease activity markers measured at baseline and 2 and 4 months. Urinary parameters, renal function test, serological markers, and renal SLE disease activity index-2K (renal SLEDAI-2K) were analyzed to determine their associations with uMCP-1. Results. A hundred patients completed the study. At each visit, uMCP-1 levels (pg/mg creatinine) were significantly higher in the active group especially with relapses and were significantly associated with proteinuria and renal SLEDAI-2K. Receiver operating characteristic (ROC) curves showed that uMCP-1 was a potential biomarker for LN. Whereas multiple logistic regression analysis showed that only proteinuria and serum albumin and not uMCP-1 were independent predictors of LN activity. Conclusion. uMCP-1 was increased in active LN. Although uMCP-1 was not an independent predictor for LN activity, it could serve as an adjunctive marker when the clinical diagnosis of LN especially early relapse remains uncertain. Larger and longer studies are indicated.

The role of urinary neutrophil gelatinase-associated lipocalin in lupus nephritis.

BACKGROUND: Urine neutrophil gelatinase-associated lipocalin (uNGAL) has been proposed as a potential biomarker for lupus nephritis (LN) activity. We determined the association between uNGAL with LN activity in systemic lupus erythematosus (SLE) patients compared to the current standard markers of SLE. METHODS: A total of 100 SLE patients with biopsy-proven LN were recruited-47 with active and 53 inactive LN. uNGAL levels were measured. Renal function test, urinary parameters, lupus serology and calculated renal SLE Disease Activity Index-2K (renal SLEDAI-2K) were analyzed to determine their associations with uNGAL. RESULTS: Normalized uNGAL levels (ng/mg creatinine) were significantly higher in patients with active LN compared to those with inactive disease (p=0.01). uNGAL and renal SLEDAI-2K were associated (r=0.32, p=0.001). Multiple logistic regression showed that only serum creatinine and renal SLEDAI-2K were independent predictors of uNGAL levels (p=0.03 and 0.02 respectively). Analysis of the receiver operating characteristic (ROC) curve showed that uNGAL was a potential biomarker for LN. CONCLUSIONS: uNGAL was increased in active LN especially in LN flares. Serial measurements of uNGAL levels may be of value in monitoring response of LN to treatment and for predicting LN flares.

Assessment of body fluid status in hemodialysis patients using the body composition monitor measurement technique.

AIMS AND OBJECTIVES: The main objective of the study was to correlate the target dry weight in haemodialysis (HD) patients as assessed clinically by nephrologists to those measured by the Body Composition Monitor (BCM - Fresenius) machine. The second objective was to compare pre and postdialysis changes of extracellular fluid and clinical parameters. BACKGROUND: Clinical assessment of target dry weight in HD patients remains problematic. Inaccurate dry weight resulted in hypovolaemic or overhydration states. The BCM (Fresenius) utilises bioimpedance technology for body fluid monitoring and has been extensively validated. DESIGN: This was a prospective cross-sectional study on consecutive patients who underwent HD and gave informed consent. Methods. The target dry weights of these patients were first assessed by their attending nephrologists and appropriate ultrafiltration prescribed. Their body fluid statuses were then measured with the BCM before and after HD treatment. RESULTS: Eighty HD patients (37 men, 43 women) with a mean age of 55 ± 13 years and a mean duration on HD of 71 ± 56 months were studied. The dry weight measured by BCM significantly correlated with dry weight assessed by the nephrologists. The mean dry weight was higher when assessed by the nephrologists compared to that by BCM. Only systolic blood pressure and not other components of blood pressure reduced after HD treatments. CONCLUSION: The BCM is a rapid and easy-to-use tool that can help HD nursing staffs to adjust patients' dry weights between nephrologists' reviews thus optimising HD therapy and patient outcomes. RELEVANCE TO CLINICAL PRACTICE: We propose that experienced HD nursing staff be trained in the use of the BCM or other simple bioimpedance machines to help monitor patient overhydration and approximate dry weight in consultation with the nephrologists responsible for the care of these patients so as to obviate excessive residual overhydration between nephrology reviews.