Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Front Immunol. 2023 Oct 3;14:1251876. doi: 10.3389/fimmu.2023.1251876. eCollection 2023.
Lupus nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus and an important cause of acute and chronic kidney injury. Early diagnosis of LN and preventing relapses are key to preserving renal reserve. However, due to the complexity and heterogeneity of the disease, clinical management remains challenging. Kidney biopsy remains the gold standard for confirming the diagnosis of LN and subsequent assessment of kidney histopathology, but it is invasive and cannot be repeated frequently. Current clinical indicators of kidney function such as proteinuria and serum creatinine level are non-specific and do not accurately reflect histopathological changes, while anti-dsDNA antibody and C3 levels reflect immunological status but not kidney injury. Identification of novel and specific biomarkers for LN is prerequisite to improve management. Renal function deterioration is associated with changes in the endothelial glycocalyx, a delicate gel-like layer located at the interface between the endothelium and bloodstream. Inflammation induces endothelial cell activation and shedding of glycocalyx constituents into the circulation. This review discusses the potential role of soluble glycocalyx components as biomarkers of active LN, especially in patients in whom conventional serological and biochemical markers do not appear helpful.
狼疮性肾炎 (LN) 是系统性红斑狼疮的一种常见且严重的表现，也是急性和慢性肾损伤的重要原因。早期诊断 LN 并预防复发是保护肾脏储备的关键。然而，由于疾病的复杂性和异质性，临床管理仍然具有挑战性。肾活检仍然是确诊 LN 以及随后评估肾脏组织病理学的金标准，但它是有创的，不能频繁重复进行。目前肾功能的临床指标，如蛋白尿和血清肌酐水平，不具有特异性，不能准确反映组织病理学变化，而抗 dsDNA 抗体和 C3 水平反映免疫状态，但不能反映肾损伤。因此，需要寻找新的、特异性的 LN 生物标志物来改善管理。肾功能恶化与内皮糖萼的变化有关，内皮糖萼是位于内皮细胞和血液之间界面的一层精细的凝胶状层。炎症诱导内皮细胞激活，糖萼成分脱落并进入循环。本综述讨论了可溶性糖萼成分作为活动性 LN 生物标志物的潜在作用，尤其是在常规血清学和生化标志物似乎没有帮助的患者中。
