Access: Lupus Research -- Lupus Nephritis
Research Summaries from 2012
Europeans at Decreased Risk of Lupus Nephritis
Lupus-related kidney disease is significantly more common in African-Americans, Hispanics, and East Asians for reasons that have not been fully explained. Genetic and/or socioeconomic factors may contribute significantly to these trends. The results of this study indicate that lupus patients of European descent are at significantly decreased risk of developing lupus-related kidney disease. This trend persisted in spite of statistical adjustments for possible differences in specific genetic markers and socioeconomic status.
Read more>> Combinations of Biomarkers Indicate Lupus Nephritis Pathology
Lupus nephritis, or lupus-related inflammation of the kidney, is one of the most common and potentially problematic aspects of systemic lupus erythematosus. Currently, a definitive diagnosis of lupus nephritis can only be made by a kidney biopsy, which involves removal of a small piece of kidney tissue for study. This procedure is invasive and, in some cases, the kidney may already be in a relatively advanced disease state at the time of the biopsy. The use of lupus biomarkers, such as those present in the blood or urine, to help predict and/or manage lupus nephritis over time could be very useful. The results of this study highlight the potential feasibility of using lupus biomarkers to differentiate between acute and chronic kidney disease activity-related changes.
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Research Summaries from 2011
Blood Test May Indicate Lupus Nephritis Activity
Inflammation of the kidneys, or lupus nephritis, is a relatively common and potentially severe manifestation of lupus. It can be difficult to accurately identify, however, without a kidney biopsy. The development of new kinds of tests that could help identify lupus nephritis disease and activity without the need for such an invasive procedure could be very useful. The researchers developed a new kind of blood test to help identify lupus nephritis disease and activity among a variety of patients with kidney disease (some with lupus and some without).
Read more>>Genetic Profiling Can Predict Some Lupus Manifestations
People with lupus can experience a wide variety of disease-related manifestations, including nephritis (kidney inflammation) and skin rashes. The variability of these symptoms likely results from underlying genetic factors. While most studies have focused on identifying the presence of specific genes that increase the risk of developing lupus, few studies have focused on which genes may give rise to which manifestations of lupus. Identification of which genes may be associated with which lupus manifestations could help facilitate the future development of personalized medicine for people with lupus.
Read more>>Comparison of Lupus Nephritis Classifications of Two International Organizations
Kidney involvement occurs in about 60% of people with lupus and is a major determinant of long-term disease outcome. The World Health Organization (WHO) published multiple versions of their classifications for lupus nephritis from 1975-2001, but they had several limitations. In 2004, the International Society of Nephrology-Renal Pathology Society (ISN-RPS) revised the WHO classifications for lupus nephritis. The researchers aimed to determine the effects of the ISN-RPS re-classifications for lupus nephritis on patient outcomes.
Read more>>Do Current Standards for Determining Lupus Kidney Flares Need Revision?
Experts generally agree that excessive protein in the urine is a common symptom of lupus nephritis, or inflammation of the kidney. However, there is little agreement about how much of an increase in urinary protein indicates a flare. Establishing agreement on what constitutes a flare of lupus kidney disease could help identify the true status of the kidney in people with lupus. The researchers aimed to define normal fluctuations in levels of urinary protein in people with lupus kidney disease who are not experiencing a flare. The researchers found that, according to current standards, patients experiencing the most common types of kidney flares would have delayed treatment for these flares. Conversely, for those with relatively high levels of urinary protein, treatment may be initiated too early. The researchers suggest that current standards for lupus kidney flares may be set too low or too high. The results of this study may one day be used to help better guide treatment strategies for lupus kidney disease.
Read more>>Biomarkers Predict Success of Lupus Nephritis Drug Therapy
Kidney involvement (nephritis) can be one of the more serious complications of lupus. Since lupus nephritis can be severe and the therapy can be toxic, it is important to be able to predict which patients would most benefit from long-term treatment. It would be particularly useful if specific factors could provide some advanced predictions about whether or not there would be successful responses to treatments for lupus nephritis. The researchers hoped to identify factors that might be seen after 8 weeks of treatment for nephritis that might predict whether or not the treatment would be successful after 24 weeks.
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Are MicroRNAs Novel Biomarkers for Lupus Nephritis?
People inherit DNA from their parents and it contains the blueprints for making all of the proteins in the body. RNA is the translating material which helps in the conversion of these blueprints into functioning proteins. MicroRNAs are small pieces of RNA that help to regulate the extent to which instructions for making specific proteins can be used for that purpose. Specific blueprints can be “turned off” by microRNAs so that some proteins won’t be made. The role of microRNAs in lupus has recently been studied. Specific microRNAs have been identified in lupus patients and in some patients who have kidney involvement (lupus nephritis). In this study, the researchers hoped to learn whether people with lupus kidney involvement from different races shared the same set of microRNAs.
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New Blood Tests May Improve the Tracking of Lupus Kidney Disease in Children
Current treatments for lupus nephritis in children are toxic and sometimes ineffective. New tests for proteins that might be abnormal in lupus nephritis could help make the diagnosis earlier (when treatments have a better chance to work more quickly) and might also point to new ways of treating the disease (possibly with fewer side effects). In this study, the researchers hoped to find new tests for lupus nephritis in children.
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Belimumab Allows For Reduction in Steroid Use for People with Lupus
One way to test whether a new treatment for lupus is effective is to see whether it allows people to reduce the amount of steroids they are taking. In this study, the researchers hoped to learn whether treatment with belimumab could reduce the use of steroids in people with active lupus.
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CellCept® Is Superior to Azathioprine in Treatment of Lupus Nephritis
There are a number of treatments used for lupus nephritis, but none of them are approved by the U.S. Food and Drug Administration (FDA). This is because the FDA requires a treatment to demonstrate that it is superior to placebo or standard of care before it can be approved. It has been hard to figure out how to design clinical trials for nephritis that allow all the patients to receive acceptable standard of care treatments because the standard of care for this more serious type of lupus flare is very aggressive. In this study, the researchers hoped to compare the efficacy and safety of CellCept® and azathioprine as maintenance therapy for lupus patients who had responded well to a six-month, initial phase of treatment.
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Research Summaries from 2010
Pregnancy Outcomes in Women with Lupus Nephritis
Lupus primarily affects women during their reproductive years and it has been reported that women having more active disease are at greater risk of flares during pregnancy. The researchers hoped to determine the specific effects of active lupus-related kidney disease (lupus nephritis or LN) on pregnancy outcomes, as well as complications that might occur in the mothers or babies.
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Successful Phase III Trial of CellCept® for Lupus Nephritis
Lupus nephritis, or inflammation of the kidney, is a somewhat common and potentially serious manifestation of lupus. There has not been a new FDA-approved treatment for lupus nephritis in over 50 years. In this study, the researchers wanted to compare the effectiveness of mycophenolate mofetil (CellCept) with that of azathioprine to prevent kidney flares after the initial treatment for nephritis was successful.
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Animal Study Sheds Light on Development of Lupus Nephritis
Knowledge about how kidney damage occurs in people with lupus is limited and researchers hope to learn more about human lupus by figuring out how to make it develop in animals. In this study, the scientists hoped to learn the role of interferons (IFNs) and macrophages (white blood cells) in the development of experimental lupus nephritis.
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Urine Protein Indicates Presence of Lupus Nephritis
Lupus nephritis (LN) means that the kidney is inflamed. Currently, most people who are suspected of having LN have to get a kidney biopsy, a procedure in which small pieces of the kidney are removed for study under a microscope. But what if the availability of urine tests for LN may mean that a kidney biopsy one day may not be necessary to accurately diagnose LN? This will be an advantage for people with lupus since a kidney biopsy is an invasive procedure, can sometimes have serious side effects, and is not a practical way to monitor LN disease activity over time.
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Urine May Help Track Kidney Disease and Predict Treatment Success in People With Lupus
Lupus nephritis (LN) -- inflammation of the kidney -- can damage the kidney’s ability to remove waste from the body. Currently, the best way to diagnose kidney inflammation is with a biopsy, an invasive procedure that can sometimes have serious side effects. Researchers have been working to develop specific tests that can be done on urine samples. The results of this study showed that levels of mRNA for FOXP3 could potentially become a test that can be done on simple urine samples to help figure out what is going on in the kidney and to help predict responses to current treatments for people with lupus.
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Research Summaries from 2009
Urine Components May Indicate Severity of Lupus Nephritis
Lupus may involve inflammation of the kidney, called lupus nephritis, which can impair the kidney’s ability to remove waste from the body. Since normal kidney function is vital, lupus nephritis requires aggressive treatments. Currently, the best way to diagnose kidney inflammation is with a biopsy, which is an invasive procedure that can sometimes have serious side effects. If there were tests that could be done to help diagnose and evaluate lupus nephritis without a biopsy, this would be a major advance for patients.
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Improving How Signs of Lupus Nephritis Are Measured
The kidneys act as filters to remove waste materials from the blood; these waste materials are then passed out of the body in the urine. Lupus that affects the kidneys, termed lupus nephritis, or LN, can cause inflammation that damages the kidney tissue. If LN is not diagnosed early and treated aggressively, this tissue damage can affect the kidneys’ ability to filter waste. If the kidneys become too damaged to function properly, a person may need to undergo regular (two-three times per week) dialysis treatments, in which the blood is circulated through a machine that removes the waste material. Lupus nephritis can eventually lead to end stage renal disease (ESRD) and the need for a kidney transplant.
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Treating Lupus Nephritis: Does Ethnicity Play a Role?
Lupus is seen two to three times more often in people of African American, Hispanic/Latino, Asian, and Native American heritage than in Caucasians. Information on how medications work in these populations may one day enable physicians and researchers to tailor treatment for each individual.
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Chronic Lesions Versus Active Lesions in Lupus Nephritis
For many years doctors have classified lupus nephritis (LN) by the extent of inflammation and where it occurs in the kidney. Under the original classification system developed in 1974 by the World Health Organization (WHO), there were six categories, or classes, of lupus nephritis, reflecting different ways in which inflammation could affect the kidney tissue. In 2003, changes to these WHO classifications were proposed. The researchers wanted to see if the new classifications could be used to predict how LN would progress and whether it would respond to treatment.
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Research Summaries from 2008
New Ways to Detect Lupus Nephritis?
Kidney disease is diagnosed through a series of laboratory tests, and usually confirmed through biopsy. Biopsy -- in which kidney tissue is removed via insertion of a needle through the person’s back and then examined under a microscope -- is the most accurate way to discover the amount of damage that has occurred from lupus disease activity. However this procedure, which typically takes place in a hospital, can be expensive, can have side effects, and would only be done after kidney disease is suspected. For these reasons, less invasive and less expensive ways to routinely measure inflammation in the kidneys and disease progression would be of great benefit.
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More Promising News About Tacrolimus
Tacrolimus is an immunosuppressant drug that helps control inflammation. It was originally developed and approved to help prevent rejection of the new organ in transplant patients, but in recent years tacrolimus has been used to treat adults with lupus or rheumatoid arthritis. The researchers wanted to know if tacrolimus could be used safely to control lupus nephritis in pediatric-onset lupus patients with long-standing disease.
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Are Increased Levels of Nitric Oxide a Sign of Kidney Damage in Lupus?
Lupus disease activity often occurs without any apparent signs or symptoms. This is especially true when lupus affects the kidneys, which is known as lupus nephritis. It is even possible for lupus to cause significant kidney damage even before a patient is diagnosed. Though there may be no visible symptoms, there are chemical changes occurring in the cells and tissues that can be measured. Therefore, a major emphasis among lupus researchers is to find ways to tell if simple laboratory tests can be used to detect otherwise silent lupus disease activity. A laboratory test that can be used in this way is called a biomarker. One potential biomarker that is being investigated is nitric oxide (chemical symbol, NO), since it is one of the chemicals involved in the body’s immune response.
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Research Summaries from 2007
New Tests for Detecting Lupus Kidney Disease?
If the kidneys are damaged, they can lose their ability to filter out waste products from the blood and serious health complications can occur. The researchers in this study wanted to know if the presence of specific antibodies in a patient’s blood could be linked to the more severe kinds of kidney disease, in particular anti-dsDNA and anti-nucleosome antibodies. After reviewing the findings, the researchers calculated that lupus patients with anti-nucleosome antibodies were seven times more likely to develop lupus nephritis, suggesting that these antibodies could help to identify individuals at risk for this serious complication of lupus.
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New Tests for Detecting Lupus Kidney Disease? #2
In several previous studies, which did not include people with lupus, it appeared that high levels of lipocalin-2 in the urine could be an early predictor of kidney damage. The researchers for this study wanted to find out if there was an association between urinary lipocalin-2 and lupus-related kidney disease. The researchers found significantly higher levels of lipocalin-2 in the urine of lupus patients with active kidney disease than in the urine of the other lupus patients or among the healthy controls.
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A potential therapy for lupus nephritis when other medications fail
Lupus nephritis (kidney disease) is a serious complication of lupus. Researchers in Sweden tested to see if providing rituximab (Rituxan®) in combination with cyclophosphamide (CYC) would be a safe and effective therapy for lupus nephritis patients who had previously not responded to CYC. The researchers found that rituximab, in combination with CYC, was effective in treating lupus nephritis in patients who had previously not responded to CYC.
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New "High Tech" Approach to "Low Tech" Urine Analysis May Provide Way for Doctors to Better Monitor Kidney Involvement of Their Lupus Patients
Kidney disease is one of the most serious and difficult complications that can occur from lupus. Now, a "high-tech" approach to a common "low-tech" test -- urine analysis -- may provide a way for doctors to better monitor the degree of kidney involvement in their lupus patients -- and might also open the door to new treatments.
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Can Kidney Biopsies Predict Outcomes for Lupus Patients with Kidney Disease?
Early kidney biopsy, conducted as soon as possible after a lupus patient shows signs of kidney complications, is widely regarded as the most-accurate way to assess the level of kidney damage that has occurred. Certain clinical information obtained through a biopsy may also help determine how the disease will progress and whether a patient will respond to treatment with cyclophosphamide.
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Study Demonstrates Need for Early Biopsies When Lupus Affects the Kidney
Many physicians are coming to the conclusion that patients with lupus should have a kidney biopsy as early as possible after the warning signs of kidney inflammation show up, so that appropriate treatment can be started quickly in order to prevent kidney damage. That is also the recommendation coming from the authors of a recently released research study investigating risk factors for serious complications of kidney disease among patients with lupus.
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Study Recommends Second Assay to Enhance Monitoring of Lupus Disease Activity
Different blood tests vary in their ability to detect antibodies to DNA (anti-DNA antibodies). In this study, 5 tests that are used widely by physicians to monitor their patients were compared and all seemed to be suitable to use to evaluate lupus disease activity.
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Blocking CD134 Stimulator May Be Effective Way to Prevent Lupus Nephritis
The immune system is triggered to promote inflammation by a complicated series of signals that pass between and among the various types of white blood cells. When white blood cells signal to each other with multiple signals at the same time, the proteins that are involved in these signals are called co-stimulation proteins. Co-stimulation signals are involved in the activation of T-cells. One co-stimulation protein, CD134, may be a marker for lupus kidney disease.
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