Urine epidermal growth factor as a biomarker for kidney function recovery and prognosis in glomerulonephritis with severe kidney function impairment.

IF 2.7 4区医学 Q2 UROLOGY & NEPHROLOGY Journal of Nephrology Pub Date : 2024-10-04 DOI:10.1007/s40620-024-02068-6

Adriana Hernández-Andrade, Alberto Nordmann-Gomes, Bernardo Juárez-Cuevas, Maria Fernanda Zavala-Miranda, Cristino Cruz, Juan M Mejía-Vilet

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Abstract

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/1.73m²): 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/1.73m² 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/1.73m². 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.

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尿液表皮生长因子作为肾功能严重受损的肾小球肾炎患者肾功能恢复和预后的生物标志物。

背景：对肾功能严重受损的肾小球肾炎患者进行预诊对于评估免疫抑制的获益风险比至关重要。我们假设尿液生物标志物表皮生长因子（EGF）具有良好的鉴别力，可识别出最终可能恢复肾功能的受试者：我们纳入了 82 名肾小球肾炎患者，他们入院时肾功能严重受损（估计肾小球滤过率 [eGFR] ≤ 30 mL/min/1.73m2）：58名患者患有狼疮性肾炎（LN），24名患者患有ANCA相关性血管炎（AAV）。35名受试者在发病时需要接受肾脏替代治疗（KRT）。对尿液表皮生长因子进行了测量，并用尿肌酐进行了校正（uEGF/Cr），然后按uEGF/Cr三分位数对人群进行了分析。主要结果是 eGFR ≥ 30 mL/min/1.73m2 的恢复时间，以及初始 KRT 患者肾功能恢复并独立透析的时间：结果：44 名参与者（54%）达到了 eGFR 恢复≥ 30 mL/min/1.73m2 的主要结果。uEGF/Cr最高、中间和最低三分位数参与者的6个月恢复率分别为93%、57%和0%。uEGF/Cr最高三分位组的肾功能恢复更快，治疗后的eGFR也更高。在 ROC 分析中，uEGF/Cr 是肾功能恢复的预测指标，其曲线下面积 (AUC) 为 0.92（95% CI 0.87-0.98），2.60 ng/mg 临界值对检测肾功能恢复患者的灵敏度为 100%。在初次接受 KRT 的参与者亚组中，uEGF/Cr 的临界值为 2.0 ng/mg，其灵敏度为 100%，可检测出在 6 个月后恢复肾功能并能独立透析的参与者：结论：尿EGF/Cr是一种很有前景的生物标记物，有助于预测肾小球肾炎伴严重肾功能损害患者的肾功能恢复情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Nephrology 医学-泌尿学与肾脏学

CiteScore

5.60

自引率

5.90%

发文量

289

审稿时长

3-8 weeks

期刊介绍： Journal of Nephrology is a bimonthly journal that considers publication of peer reviewed original manuscripts dealing with both clinical and laboratory investigations of relevance to the broad fields of Nephrology, Dialysis and Transplantation. It is the Official Journal of the Italian Society of Nephrology (SIN).