Obrișcă Bogdan, Vrabie Alexandra, Lujinschi Ștefan, Jurubiță Roxana, Mocanu Valentin, Berechet Andreea, Sorohan Bogdan, Andronesi Andreea, Lupușoru Gabriela, Achim Camelia, Micu Georgia, Manda Dana, Poalelungi Catalina, Caceaune Nicu, Dima Simona, Ismail Gener
Nephrology Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania.
J Clin Med. 2025 Aug 31;14(17):6162. doi: 10.3390/jcm14176162.
: We sought to evaluate the clinical predictors of underlying histologic activity in patients with lupus nephritis (LN), with a focus on urinary soluble protein CD163 (usCD163). : We conducted a retrospective, cross-sectional study of forty-two consecutive LN patients with concurrent determination of usCD163 at the moment of kidney biopsy. A first morning void prior to the kidney biopsy was collected and usCD163 was measured by a commercial ELISA assay (EUROIMMUN, Lubeck, DE). : The study cohort had a median age at the moment of kidney biopsy of 33.5 (IQR: 24-42.7) years. The mean eGFR and median 24 h proteinuria were 76.6 ± 33.9 mL/min/1.73 m and 1.98 (IQR: 0.83-4.52) g/day. The median activity (AI) and chronicity (CI) indices were 7 (IQR: 3-11) and 3 (IQR: 1-5), respectively. usCD163 significantly correlated with 24 h proteinuria ( = 0.7, < 0.001), hematuria ( = 0.51, < 0.001), and serum complement levels, C3 ( = -0.5, = 0.001) and C4 ( = -0.32, = 0.03), but not with eGFR ( = -0.23, = 0.14). Regarding the histological parameters, usCD163 significantly correlated with the AI and the individual active lesions (except for fibrinoid necrosis), but not with CI or any chronic lesion. usCD163 had a higher AUC compared to the classical measures of renal involvement (proteinuria, hematuria, eGFR) for discriminating an elevated AI, but the differences between AUC reached statistical significance only for hematuria. Thus, the AUC of usCD163 was 0.74 (95%CI, 0.58-0.86) for an AI over 2, an AUC of 0.77 (95%CI, 0.61-0.88) for an AI over 3 and an AUC of 0.74 (95%CI, 0.57-0.86) for an AI of at least 9. The optimal cutoff value for usCD163 identified for all AI thresholds evaluated was 296.2 ng/mmol. usCD163 correlates with glomerular inflammation, being able to discriminate histologic activity from chronicity in patients with LN and identify minimal histologic activity, although it did not significantly outperform proteinuria.
我们旨在评估狼疮性肾炎（LN）患者潜在组织学活动的临床预测指标，重点关注尿可溶性蛋白CD163（usCD163）。我们对42例连续的LN患者进行了一项回顾性横断面研究，在肾活检时同时测定usCD163。在肾活检前收集首次晨尿，采用商业ELISA检测法（EUROIMMUN，吕贝克，德国）测定usCD163。研究队列在肾活检时的中位年龄为33.5岁（四分位间距：24 - 42.7岁）。平均估算肾小球滤过率（eGFR）和24小时蛋白尿中位数分别为76.6 ± 33.9 mL/min/1.73 m²和1.98 g/天（四分位间距：0.83 - 4.52 g/天）。中位活动指数（AI）和慢性指数（CI）分别为7（四分位间距：3 - 11）和3（四分位间距：1 - 5）。usCD163与24小时蛋白尿（r = 0.7，P < 0.001）、血尿（r = 0.51，P < 0.001）以及血清补体水平C3（r = -0.5，P = 0.001）和C4（r = -0.32，P = 0.03）显著相关，但与eGFR无关（r = -0.23，P = 0.14）。关于组织学参数，usCD163与AI和各个活动性病变（除纤维素样坏死外）显著相关，但与CI或任何慢性病变无关。在区分升高的AI方面，与肾脏受累的经典指标（蛋白尿、血尿、eGFR）相比，usCD163的曲线下面积（AUC）更高，但仅血尿的AUC差异具有统计学意义。因此，对于AI大于2，usCD163的AUC为0.74（95%置信区间，0.58 - 0.86）；对于AI大于3，AUC为0.77（95%置信区间，0.61 - 0.88）；对于AI至少为9，AUC为0.74（95%置信区间，0.57 - 0.86）。针对所有评估的AI阈值确定的usCD16'3最佳截断值为296.2 ng/mmol。usCD163与肾小球炎症相关，能够区分LN患者的组织学活动与慢性病变，并识别最小组织学活动，尽管其表现并未显著优于蛋白尿。
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