Biomarkers for Kidney Involvement in Pediatric Lupus

Abstract

Lupus nephritis (LN), the renal involvement in systemic lupus erythematosus, is currently diagnosed by histopathology obtained by percutaneous renal biopsy and is associated with increased morbidity and mortality in both adults and children. LN is more prevalent and severe in children, requiring aggressive and prolonged immunosuppression. The consequences of the diagnosis and its treatment have devastating long-term effects on the growth, well-being and quality of life of affected children. The paucity of reliable clinical indicators of the presence and severity of renal involvement have contributed to a halt in the reduction of progression to end-stage renal disease in recent years. Here, we discuss the recent development of biomarkers in the management of LN and their role as therapeutic targets.

Hematuria and Proteinuria in Children

“…The clinical presentation of SLE does not always correlate well with the severity of the histopathologic findings, and, because there is no reliable biomarker available that correlates well with disease activity, a renal biopsy should be considered when GN is suspected, including in the case of persistent mild proteinuria. (62)(65) All children with SLE should have close monitoring of blood pressure, serum creatinine level, proteinuria, and hematuria because renal disease can also be representative of disease flares, even after remission. (62)(65) For patients with previous active SLE nephritis, follow-up is recommended every 3 months.…”

“…(62)(65) All children with SLE should have close monitoring of blood pressure, serum creatinine level, proteinuria, and hematuria because renal disease can also be representative of disease flares, even after remission. (62)(65) For patients with previous active SLE nephritis, follow-up is recommended every 3 months. (66)…”

Interleukin-35 as a New Biomarker of Renal Involvement in Lupus Nephritis Patients

“…The pathogenesis for lupus nephritis (LN) is complex and involves complicated interaction among genetic and environmental factors, and the innate and adaptive immune systems (Koutsokeras and Healy 2014). LN is currently diagnosed by histopathology of the specimen obtained by percutaneous renal biopsy and is associated with increased morbidity and mortality (Weening et al 2004;Goilav et al 2015). The kidney biopsy allows for some risk stratification, and provides a snapshot of the degree of scarring and irreversible damage (Goilav et al 2015).…”

“…LN is currently diagnosed by histopathology of the specimen obtained by percutaneous renal biopsy and is associated with increased morbidity and mortality (Weening et al 2004;Goilav et al 2015). The kidney biopsy allows for some risk stratification, and provides a snapshot of the degree of scarring and irreversible damage (Goilav et al 2015). The procedure of the kidney biopsy, however, requires the involvement of several medical teams and prolonged observation post procedure, and is also associated with a risk of bleeding, infection and allergic reactions to anesthetics and sedatives (Goilav et al 2015).…”

“…The kidney biopsy allows for some risk stratification, and provides a snapshot of the degree of scarring and irreversible damage (Goilav et al 2015). The procedure of the kidney biopsy, however, requires the involvement of several medical teams and prolonged observation post procedure, and is also associated with a risk of bleeding, infection and allergic reactions to anesthetics and sedatives (Goilav et al 2015). It has thus become clear that there is a real need for a better understanding of the pathogenesis of SLE and investigating surrogate markers to predict and monitor renal involvement in LN.…”