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Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Arthritis+Care+Res+(Hoboken) 2016 ; 68 (7): 1003-11 Nephropedia Template TP
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DEVELOPMENT OF A NOVEL RENAL ACTIVITY INDEX OF LUPUS NEPHRITIS IN CHILDREN & YOUNG ADULTS #MMPMID26473509
Arthritis Care Res (Hoboken) 2016[Jul]; 68 (7): 1003-11 PMID26473509show ga
Background: Noninvasive estimation of the degree of inflammation seen on kidney biopsy with lupus nephritis (LN) remains difficult. The objective of this study was to develop a Renal Activity Index for Lupus (RAIL) that, based solely on laboratory measures, accurately reflects histological LN activity. Methods: We assayed traditional LN laboratory tests and 16 urine biomarkers (UBMs) in children (n=47) at the time of kidney biopsy. Histological LN activity was measured by the NIH Activity Index (NIH-AI) and the Tubulointerstitial Activity Index (TIAI). High LN-activity status (vs. moderate/low) was defined as NIH-AI scores > 10 (vs. ? 10) or TIAI scores >5 (vs. ? 5). RAIL algorithms that predicted LN-activityNIH-AI and LN-activityTIAI status were derived by stepwise multivariate logistical regression, considering traditional biomarkers and UBMs as candidate components. The accuracy of the RAIL for discriminating by LN-activity status was determined. Results: The differential excretion of six UBMs (NGAL, MCP-1, ceruloplasmin, adiponectin, hemopexin, KIM-1) standardized by urine creatinine was considered in the RAIL. These UBMs predicted LN-activityNIH-AI status with >92% accuracy and LN-activityTIAI status with >80% accuracy. RAIL accuracy was minimally influenced by concomitant LN damage. Accuracies between 71 and 85% were achieved without standardization of the UBMs. The strength of these UBMs to reflect LN-activity status was confirmed by principal component and linear discriminant analyses. Conclusion: The RAIL is a robust and highly accurate noninvasive measure of LN-activity. The measurement properties of the RAIL, which reflect the degree of inflammatory changes as seen on kidney biopsy, will require independent validation.