In a new study, researchers examined the Renal Activity Index for Lupus (RAIL) diagnostic tool to assess its success for identification and prediction of active lupus nephritis, (LN, lupus-related kidney disease) treatment response in adults. A RAIL score is derived from a panel of urinary biomarkers and was developed as a noninvasive tool for diagnosing and monitoring LN in children. Researchers found RAIL scores can distinguish active LN and predict the clinical response course of adult LN over time. Although treatments for lupus have improved, LN is still a serious and common complication that causes significant illness and death. 

Researchers analyzed urine samples collected through week 52 from a subgroup of 240 adults with active biopsy-confirmed proliferative LN enrolled in the double-blind, randomized ALLURE trial. RAIL-scores were calculated from creatinine-adjusted urine biomarkers (NGAL, KIM-1, MCP-1, adiponectin, hemopexin, ceruloplasmin) and were compared with urine protein-to-creatinine-ratio (UPCR), kidney function (eGFR), and renal response states including complete renal response (CRR), partial renal response but not CRR (PRR-only), and non-response. The RAIL biomarkers were able to predict future renal response state in adults with LN and the researchers concluded the RAIL-score is an effective, non-invasive tool for assessing kidney activity and treatment response over time in adults with LN.

Findings demonstrate the clinical relevance of the RAIL biomarkers and RAIL score as noninvasive tools to assess kidney inflammation and therapeutic response in adults with LN. The results highlight their potential to inform early treatment decisions, identify people with lupus who may benefit from therapy intensification, and facilitate a more personalized monitoring strategy. Learn more about how doctors diagnose lupus.

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