Urinary peptides as potential non‐invasive biomarkers for lupus nephritis: Results of the peptidu‐lup study

Abstract

Background: Lupus nephritis (LN) is a severe manifestation of Systemic Lupus Erythematosus (SLE). The therapeutic strategy relies on kidney biopsy (KB) results. We tested whether urinary peptidome analysis could non‐invasively differentiate active from non‐active LN. Design: Urinary samples were collected from 93 patients (55 with active LN and 38 with non‐active LN), forming a discovery (n = 42) and an independent validation (n = 51) cohort. Clinical characteristics were collected at inclusion and prospectively for 24 months. The urinary peptidome was analyzed by capillary‐electrophoresis coupled to mass‐spectrometry, comparing active LN to non‐active LN, and assessing chronic lesions and response to therapy. The value of previously validated prognostic (CKD273) and differential diagnostic (LN172) signatures was evaluated. Results: Urinary peptides could not discriminate between active and non‐active LN or predict early response to therapy. Tubulo‐interstitial fibrosis was correlated to the CKD273. The LN172 score identified 92.5% of samples as LN. Few patients developed new‐onset CKD. Conclusions: We validated the CKD273 and LN172 classifiers but did not identify a robust signature that could predict active LN and replace KB. The value of urinary peptidome to predict long‐term CKD, or renal flares in SLE, remains to be evaluated.