尿表皮生长因子作为重度肾功能损害的肾小球肾炎患者肾功能恢复及预后的生物标志物。
Urine epidermal growth factor as a biomarker for kidney function recovery and prognosis in glomerulonephritis with severe kidney function impairment.
作者信息
Hernández-Andrade Adriana, Nordmann-Gomes Alberto, Juárez-Cuevas Bernardo, Zavala-Miranda Maria Fernanda, Cruz Cristino, Mejía-Vilet Juan M
机构信息
Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 15 Vasco de Quiroga, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, 14380, Mexico.
School of Medicine, Universidad Panamericana, Mexico City, Mexico.
出版信息
J Nephrol. 2024 Nov;37(8):2243-2253. doi: 10.1007/s40620-024-02068-6. Epub 2024 Oct 4.
BACKGROUND
Prognostication in glomerulonephritis with severe kidney function impairment is critical for evaluating the benefit-to-risk ratio of immunosuppression. We hypothesized that the urine biomarker epidermal growth factor (EGF) could have good discrimination power to identify subjects who might ultimately recover kidney function.
METHODS
We included 82 subjects with glomerulonephritis and severe kidney function impairment at admission (estimated glomerular filtration rate [eGFR] ≤ 30 mL/min/1.73m): 58 with lupus nephritis (LN) and 24 with ANCA-associated vasculitis (AAV). Thirty-five subjects required kidney replacement therapy (KRT) at presentation. Urine epidermal growth factor was measured and corrected by urine creatinine (uEGF/Cr) and the population was analyzed by uEGF/Cr tertiles. The primary outcome was time to recovery of eGFR ≥ 30 mL/min/1.73m and time to recovery of kidney function with dialysis independence in those with initial KRT.
RESULTS
Forty-four (54%) participants met the primary outcome of recovery of eGFR ≥ 30 mL/min/1.73m. The 6-month recovery rates were 93%, 57%, and 0% for participants in the highest, middle, and lowest uEGF/Cr tertile, respectively. Recovery of the kidney function was faster and led to a higher post-therapy eGFR in the highest uEGF/Cr tertile. In the ROC analysis, uEGF/Cr was a predictor of recovery with an area under the curve (AUC) of 0.92 (95% CI 0.87-0.98), and a cutoff of 2.60 ng/mg had 100% sensitivity to detect patients who recovered kidney function. In the subgroup of participants with initial KRT, the cut-off of uEGF/Cr of 2.0 ng/mg had 100% sensitivity to detect participants who recovered kidney function with dialysis independence by 6 months.
CONCLUSIONS
Urine EGF/Cr is a promising biomarker to aid in the prediction of recovery of kidney function in glomerulonephritis with severe kidney function impairment.
背景
对于肾功能严重受损的肾小球肾炎患者，预后评估对于判断免疫抑制治疗的风险效益比至关重要。我们推测尿生物标志物表皮生长因子（EGF）可能具有良好的鉴别能力，能够识别出最终可能恢复肾功能的患者。
方法
我们纳入了82例入院时患有肾小球肾炎且肾功能严重受损（估计肾小球滤过率[eGFR]≤30 mL/min/1.73m²）的患者：58例为狼疮性肾炎（LN），24例为抗中性粒细胞胞浆抗体相关性血管炎（AAV）。35例患者在就诊时需要肾脏替代治疗（KRT）。测量尿表皮生长因子并通过尿肌酐进行校正（uEGF/Cr），并根据uEGF/Cr三分位数对患者群体进行分析。主要结局为eGFR恢复至≥30 mL/min/1.73m²的时间，以及初始接受KRT的患者恢复肾功能且无需透析的时间。
结果
44例（54%）参与者达到了eGFR恢复至≥30 mL/min/1.73m²的主要结局。uEGF/Cr三分位数最高、中间和最低组的参与者6个月恢复率分别为93%、57%和0%。uEGF/Cr三分位数最高组的肾功能恢复更快，治疗后的eGFR更高。在ROC分析中，uEGF/Cr是恢复的预测指标，曲线下面积（AUC）为0.92（95%CI 0.87 - 0.98），截断值为2.60 ng/mg时，检测肾功能恢复患者的灵敏度为100%。在初始接受KRT的参与者亚组中，uEGF/Cr截断值为2.0 ng/mg时，检测6个月内恢复肾功能且无需透析的参与者的灵敏度为100%。
结论
尿EGF/Cr是一种有前景的生物标志物，有助于预测肾功能严重受损的肾小球肾炎患者的肾功能恢复情况。
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