Browsing by Author "Rusch, Jody Alan"
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- ItemOpen AccessCorrelation of urinary mcp-1 and tweak with renal histology and early response to therapy in newly biopsied patients with lupus nephritis in cape town, South Africa(2019) Moloi, Mothusi Walter; Okpechi, Ikechi; Rusch, Jody AlanBackground: There is need for judicious use of immunosuppression in patients with active lupus nephritis (LN), however this is guided by renal biopsy which is invasive and not freely available in most centres. Novel urinary biomarkers such as monocyte chemoattractant protein-1 (MCP-1) and tumour necrosis factor-like weak inducer of apoptosis (TWEAK) are secreted in the kidney and may be useful for predicting histological class, monitoring flares and assessing response to therapy. We assessed the utility of urinary MCP-1 (uMCP-1) and TWEAK (uTWEAK) in predicting renal histological findings, disease flares and treatment response 6 months following initiation of treatment for LN in newly biopsied patients. Methods: We recruited consenting patients with active LN confirmed on kidney biopsy. Relevant baseline demographic, biochemical and histological information was collected from the patients. ELISA methods were used to assess uMCP-1 and uTWEAK at baseline and at 6 months after completion of induction therapy. Results: There were 14 females and 6 male patients with a mean age of 29.8 ± 10.7 years, 60% were of mixed ancestry, 70% had proliferative LN. There was no association between uMCP-1 and uTWEAK and histological features (LN class, activity index, chronicity index and interstitial fibrosis). At 6 months, 6 patients were lost to follow-up and of the remaining 14, 12 (85%) attained remission (partial remission (n = 7) or complete remission (n = 5)). Both biomarkers were elevated in patients with active disease and significantly declined amongst those attaining remission, p = 0.018 and p = 0.015 respectively. However, for those not attaining remission, no association was found for both biomarkers (p >0.05). Conclusion: Our study did not show correlation between uMCP-1 and uTWEAK with histological features of LN. However, both biomarkers were elevated in patients with active disease and correlated with the remission status at the end of induction phase of treatment.
- ItemOpen AccessUsing urinary MCP-1 and TWEAK to assess disease activity in a cohort of South African patients with lupus nephritis(2020) Rusch, Jody Alan; Okpechi, Ikechi Gareth; Omar, FierdozBackground: Renal involvement is common in systemic lupus erythematosus (SLE) and can lead to chronic kidney disease (CKD). Diagnosis of lupus nephritis (LN) is dependent on renal biopsy. Due to its invasiveness, repeat renal biopsy for monitoring disease activity is not recommended, thus creating a need for noninvasive and accurate biomarkers. Monocyte chemoattractant protein-1 (MCP-1) and tumour necrosis factor-like weak inducer of apoptosis (TWEAK) have been implicated in the pathogenesis of LN and are thus potential biomarkers for disease activity monitoring. Methods: In this study urinary MCP-1 (uMCP-1) and TWEAK (uTWEAK), together with standard markers of disease activity, were analysed in a cohort of 50 biopsy-proven LN patients at baseline, after sixmonths of induction therapy, and at one-year. Results: Throughout the study there was correlation between uMCP-1 and uTWEAK (r=0.52, p< 0.001). Both biomarkers also correlated with standard of care tests and clinical scores. The median [interquartile range] of uMCP-1 and uTWEAK were significantly increased in the active group when compared to the quiescent group (1440 [683–2729] vs 256 [175–477] pg/mL, p< 0.0001, and 209 [117–312] vs 74 [11– 173] pg/mL, p=0.0008, respectively). After completion of induction therapy in the active group, there was no significant difference in biomarker results between the groups. The sensitivity and specificity for indicating disease activity was 95% and 73% for uMCP-1 (area under curve [AUC]=0.875), and 60% and 90% for uTWEAK (AUC=0.783), respectively. Conclusion: uMCP-1 and uTWEAK reflect LN disease activity, and correlate with standard of care biomarkers in a South African cohort. Further studies are needed to assess additional clinical benefit.