Neutrophil gelatinase-associated lipocalin is a urine-based biomarker for diagnosing active lupus nephritis
DOI:
https://doi.org/10.3329/bsmmuj.v18i2.76621Keywords:
SLE, lupus nephritis, urinary NGALAbstract
Background: Lupus nephritis is one of the most serious complications of systemic lupus erythematosus (SLE). Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a non-invasive biomarker that may aid in diagnosing active lupus nephritis. This study seeks to evaluate NGAL as a urine-based biomarker to diagnose active lupus nephritis.
Methods: This cross-sectional study was conducted in the Department of Laboratory Medicine, Rheumatology, and Nephrology at Bangabandhu Sheikh Mujib Medical University. Urine samples were collected to estimate NGAL levels using the ELISA method in the Department of Laboratory Medicine. Participants were divided into three groups: patients with SLE and active lupus nephritis, patients without nephritis, and healthy controls. Each group was comprised of 24 individuals. Patients with active lupus nephritis were classified into six categories (I to VI). ANOVA was performed to compare urinary NGAL values across the groups or categories. A receiver operating characteristic curve was created to establish the cut-off point for NGAL.
Results: The mean urinary NGAL level was 19.5 (SD 6.9), 7.2 (3.8), and 1.7 (6.5) ng/mL in SLE patients with active lupus nephritis, SLE patients without active lupus nephritis, and healthy individuals, respectively. Increasing mean levels were observed across the classes of lupus nephritis. The cut-off point for urinary NGAL in active lupus nephritis was 11.6 ng/mL, demonstrating a sensitivity of 83.3% and a specificity of 93.8%.
Conclusion: The level of urinary NGAL was elevated in SLE patients with active lupus nephritis. It could serve as a valuable biomarker for diagnosing active lupus nephritis.
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Arriens C, Wren JD, Munroe ME, Mohan C. Systemic lupus erythematosus biomarkers: the challenging quest. Rheumatology (Oxford). 2017 Apr 1;56(suppl_1):i32-i45. doi: https://doi.org/10.1093/rheumatology/kew407
Ameer MA, Chaudhry H, Mushtaq J, Khan OS, Babar M, Hashim T, Zeb S, Tariq MA, Patlolla SR, Ali J, Hashim SN, Hashim S. An Overview of Systemic Lupus Erythematosus (SLE) Pathogenesis, Classification, and Management. Cureus. 2022 Oct 15;14(10):e30330. doi: https://doi.org/10.7759/cureus.30330
Weckerle CE, Niewold TB. The unexplained female predominance of systemic lupus erythematosus: clues from genetic and cytokine studies. Clin Rev Allergy Immunol. 2011 Feb;40(1):42-49. doi: https://doi.org/10.1007/s12016-009-8192-4
Tian J, Zhang D, Yao X, Huang Y, Lu Q. Global epidemiology of systemic lupus erythematosus: a comprehensive systematic analysis and modelling study. Ann Rheum Dis. 2023 Mar;82(3):351-356. doi: https://doi.org/10.1136/ard-2022-223035
Leong PY, Huang JY, Chiou JY, Bai YC, Wei JC. The prevalence and incidence of systemic lupus erythematosus in Taiwan: a nationwide population-based study. Sci Rep. 2021 Mar 11;11(1):5631. doi: https://doi.org/10.1038/s41598-021-84957-5
Mok CC. Biomarkers for lupus nephritis: a critical appraisal. J Biomed Biotechnol. 2010;2010:638413. doi: https://doi.org/10.1155/2010/638413
Aragón CC, Tafúr RA, Suárez-Avellaneda A, Martínez MT, Salas AL, Tobón GJ. Urinary biomarkers in lupus nephritis. J Transl Autoimmun. 2020 Feb 13;3:100042. doi: https://doi.org/10.1016/j.jtauto.2020.100042
Ahmmad AM, Yeasmin S, Islam MN, Akter MS, Islam MS. Pattern of Initial Clinical Presentation of Systemic Lupus Erythematosus: A Hospital-Based Cross-Sectional Study from Bangladesh. Mymensingh Med J. 2022 Jul;31(3):812-818. PMID: 35780368
Ortega LM, Schultz DR, Lenz O, Pardo V, Contreras GN. Review: Lupus nephritis: pathologic features, epidemiology and a guide to therapeutic decisions. Lupus. 2010 Apr;19(5):557-574. doi: https://doi.org/10.1177/0961203309358187
Kuwabara T, Mori K, Mukoyama M, Kasahara M, Yokoi H, Saito Y, Yoshioka T, Ogawa Y, Imamaki H, Kusakabe T, Ebihara K, Omata M, Satoh N, Sugawara A, Barasch J, Nakao K. Urinary neutrophil gelatinase-associated lipocalin levels reflect damage to glomeruli, proximal tubules, and distal nephrons. Kidney Int. 2009 Feb;75(3):285-294. doi: https://doi.org/10.1038/ki.2008.499
Kjeldsen L, Johnsen AH, Sengeløv H, Borregaard N. Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase. J Biol Chem. 1993 May 15;268(14):10425-10432. PMID: 7683678
Janas RM, Ochocińska A, Snitko R, Dudka D, Kierkuś J, Teisseyre M, Najberg E. Neutrophil gelatinase-associated lipocalin in blood in children with inflammatory bowel disease. J Gastroenterol Hepatol. 2014 Nov;29(11):1883-1889. doi: https://doi.org/10.1111/jgh.12597
Ibrahim WHM, Sabry AA, Abdelmoneim AR, Marzouk HFA, AbdelFattah RM. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (uKIM-1) as markers of active lupus nephritis. Clin Rheumatol. 2024 Jan;43(1):167-174. doi: https://doi.org/10.1007/s10067-023-06698-2
Morris El Shahawy MS, Hemida MH, Abdel-Hafez HA, El-Baz TZ, Lotfy AM, Emran TM. Urinary neutrophil gelatinase-associated lipocalin as a marker for disease activity in lupus nephritis. Scand J Clin Lab Invest. 2018 Jul;78(4):264-268. doi: https://doi.org/10.1080/00365513.2018.1449242
Blank M, Shoenfeld Y, Perl A. Cross-talk of the environment with the host genome and the immune system through endogenous retroviruses in systemic lupus erythematosus. Lupus. 2009 Nov;18(13):1136-1143. doi: https://doi.org/10.1177/0961203309345728
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Copyright (c) 2025 Anthony Chakma, Debatosh Paul, Sheuly Ferdoushi, Minhaj Rahim Choudhury, Md. Saiful Islam
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