The Blood Clotting Proteins In Urine As Biomarkers Of Lupus Nephritis

The study reporting in arthritis research and therapy that clotting proteins; both those that promote blood clots (pro-thrombotic) and those that work to dissipate them; are elevating in the urine of patients who suffer from lupus nephritis; and anti-thrombotic molecules such as tissue factor pathway inhibitor; and fibrinolytic molecules such as plasmin and d-dimer as biomarkers of lupus nephritis.

The discovery of the new biomarker for active lupus nephritis opens the door for clinical monitoring of the disease. But among the proteins examining, urine plasmin emerging as the strongest independent predictor of kidney function and renal disease status. Urine biomarkers represent promising candidates for the early diagnosis as well as the monitoring of disease activity and therapeutic responses in lupus nephritis.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multiple organ involvement, characterized by diverse autoantibody production, notably anti-DNA and anti-nuclear antibodies. Lupus nephritis (LN) is one of the most frequent and severe clinical manifestations of SLE, representing a leading cause of morbidity and mortality.

Clotting proteins as biomarkers

The systemic lupus erythematosus is an autoimmune disease that occurs when the body attacks its own tissues and organs. Inflammation from the disease can impact many different parts of the body including joints, skin, kidneys, blood cells, brain and heart. Lupus nephritis is one of the most frequent; and severe clinical manifestations of SLE, representing a leading cause of morbidity and mortality.

New immuno suppressive drugs and biologics have brought improvements in recent SLE and LN survival rates; but early diagnosis and monitoring disease flares are still challenges that need to be addressed. Renal biopsy remains the gold standard for the diagnosis and prognosis of LN, but it’s invasive and cannot be used for routine monitoring of disease activity and treatment responses.

Non-invasive biomarkers

Because of this, several studies focusing on screening; and identifying non-invasive biomarkers for the early diagnosis and monitoring of SLE and Lupus nephritis are emerging. Because coagulation system disorders have been reported in SLE and lupus nephritis patients and the frequency of thrombotic events was documented to be higher in SLE patients than in the general population.

Finding elevations in both pro-thrombotic and thrombolytic proteins in the urine of patients with lupus nephritis was unexpecting. Both thrombogenic and thrombolytic cascades appear to be upregulated in lupus nephritis; with proteins from both cascades appearing in the urine. Of the coagulation cascade proteins surveyed; urine plasmin emerges as the strongest predictor of eGFR and clinical renal disease in patients with lupus nephritis.