Guo Qianyu, Qiao Pengyan, Wang Juanjuan, Zhao Li, Guo Zhiying, Li Xiaochen, Fan Xiuying, Yu Chong, Zhang Liyun
Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
Department of Rheumatology, Shanxi Bethune Hospital, Taiyuan, China.
Front Pharmacol. 2024 Jul 22;15:1421657. doi: 10.3389/fphar.2024.1421657. eCollection 2024.
Lupus nephritis (LN), a leading cause of death in Systemic Lupus Erythematosus (SLE) patients, presents significant diagnostic and prognostic challenges. Although renal pathology offers critical insights regarding the diagnosis, classification, and therapy for LN, its clinical utility is constrained by the invasive nature and limited reproducibility of renal biopsies. Moreover, the continuous monitoring of renal pathological changes through repeated biopsies is impractical. Consequently, there is a growing interest in exploring urine as a non-invasive, easily accessible, and dynamic "liquid biopsy" alternative to guide clinical management. This paper examines novel urinary biomarkers from a renal pathology perspective, encompassing cellular components, cytokines, adhesion molecules, auto-antibodies, soluble leukocyte markers, light chain fragments, proteins, small-molecule peptides, metabolomics, urinary exosomes, and ribonucleic acids. We also discuss the application of combined models comprising multiple biomarkers in assessing lupus activity. These innovative biomarkers and models offer insights into LN disease activity, acute and chronic renal indices, fibrosis, thrombotic microangiopathy, podocyte injury, and other pathological changes, potentially improving the diagnosis, management, and prognosis of LN. These urinary biomarkers or combined models may serve as viable alternatives to traditional renal pathology, potentially revolutionizing the method for future LN diagnosis and observation.
狼疮性肾炎（LN）是系统性红斑狼疮（SLE）患者死亡的主要原因，带来了重大的诊断和预后挑战。尽管肾脏病理学为LN的诊断、分类和治疗提供了关键见解，但其临床应用受到肾活检的侵入性和有限的可重复性的限制。此外，通过重复活检持续监测肾脏病理变化是不切实际的。因此，人们越来越有兴趣探索尿液作为一种非侵入性、易于获取且动态的“液体活检”替代方法来指导临床管理。本文从肾脏病理学角度研究了新型尿液生物标志物，包括细胞成分、细胞因子、黏附分子、自身抗体、可溶性白细胞标志物、轻链片段、蛋白质、小分子肽、代谢组学、尿液外泌体和核糖核酸。我们还讨论了包含多种生物标志物的联合模型在评估狼疮活动中的应用。这些创新的生物标志物和模型为LN疾病活动、急慢性肾脏指标、纤维化、血栓性微血管病、足细胞损伤和其他病理变化提供了见解，有可能改善LN的诊断、管理和预后。这些尿液生物标志物或联合模型可能成为传统肾脏病理学的可行替代方法，有可能彻底改变未来LN的诊断和观察方法。
