TY - JOUR T1 - Urine Biomarkers to Predict Response to Lupus Nephritis Therapy in Children and Young Adults JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.161128 SP - jrheum.161128 AU - Hermine I. Brunner AU - Michael R. Bennett AU - Gaurav Gulati AU - Khalid Abulaban AU - Marisa S. Klein-Gitelman AU - Stacy P. Ardoin AU - Lori B. Tucker AU - Kelly A. Rouster-Stevens AU - David Witte AU - Jun Ying AU - Prasad Devarajan Y1 - 2017/06/15 UR - http://www.jrheum.org/content/early/2017/06/09/jrheum.161128.abstract N2 - Objective To delineate urine biomarkers that forecast response to therapy of lupus nephritis (LN). Methods Starting from the time of kidney biopsy, patients with childhood-onset systemic lupus erythematosus who were diagnosed with LN were studied serially. Levels of 15 biomarkers were measured in random spot urine samples, including adiponectin, α-1-acid glycoprotein (AGP), ceruloplasmin, hemopexin, hepcidin, kidney injury molecule 1, monocyte chemotactic protein-1, lipocalin-like prostaglandin D synthase (LPGDS), transforming growth factor-β (TGF-β), transferrin, and vitamin D binding protein (VDBP). Results Among 87 patients (mean age 15.6 yrs) with LN, there were 37 treatment responders and 50 nonresponders based on the American College of Rheumatology criteria. At the time of kidney biopsy, levels of TGF-β (p < 0.0001) and ceruloplasmin (p = 0.006) were significantly lower among responders than nonresponders; less pronounced differences were present for AGP, hepcidin, LPGDS, transferrin, and VDBP (all p < 0.05). By Month 3, responders experienced marked decreases of adiponectin, AGP, transferrin, and VDBP (all p < 0.01) and mean levels of these biomarkers were all outstanding (area under the receiver-operating characteristic curve ≥ 0.9) for discriminating responders from nonresponders. Patient demographics and extrarenal disease did not influence differences in biomarker levels between response groups. Conclusion Low urine levels of TGF-β and ceruloplasmin at baseline and marked reduction of AGP, LPGDS, transferrin, or VDBP and combinations of other select biomarkers by Month 3 are outstanding predictors for achieving remission of LN. If confirmed, these results can be used to help personalize LN therapy. ER -