ASSESSMENT OF ROLE OF URINARY HEPARANASE IN LUPUS NEPHRITIS PATIENTS AND ITS CORRELATION WITH DISEASE ACTIVITY

Background: Lupus nephritis (LN) is one of the most common and serious complication of Systemic Lupus Erythrematosus (SLE) and assessment of its activity is crucial. Heparanase has been proposed to be important in the pathogenesis of proteinuria in various forms of glomerulonephritis. Objectives: To assess the ability of urinary heparanase to identify SLE with nephritis and the relation of this marker to lupus activity. Methods: This cross sectional study was carried out on 90 subjects; 70 patients with SLE and 20 healthy volunteers as a control. All patients and controls were subjected to full history taking and complete clinical examination, routine investigations. Immunological assay and assessment of disease activity by systemic lupus erythematosus disease activity index (SLEDAI) score, renal SLEDAI (r-SLEDAI) were done for lupus nephritis group. The lupus patients were divided according to SLEDAI score into 4 groups; 20 with active lupus nephritis, 17 with non-active LN, 18 with active lupus without renal involvement, 15 with non-active lupus without renal involvement. Urinary Heparanase levels were measured by using ELISA for all groups. Results: The level of urinary heparanase was significantly higher in LN groups than non-LN groups and control. It was also significantly higher in active LN than non-active LN patients. There was a significant positive correlation between urinary heparanase and 24 hours urinary proteins, total SLEDAI, and r-SLEDAI, and significant negative correlation between urinary heparanase and C3 & C4. ROC curve analysis revealed that urinary heparanase predicted presence of lupus nephritis activity with a sensitivity of 80%, and a specificity of 91.43%. Conclusion: Urinary heparanase levels are increased in patients with active LN and correlate with disease activity markers, indicating that it can serve as a new useful biomarker for lupus nephritis activity. REFERENCES: [1] Kim K-J, Kim J-Y, Park S-J, Baek I-W, Yoon C-H, Kim W-U, et al. SAT0227 Urinary heparanase activity is elevated in patients with lupus nephritis and correlate with protein excretion. Annals of the Rheumatic Diseases. 2013;71(Suppl 3):548-9. [2] Cho C, Kim K, In-Woon B. 206 Increased urinary heparanase levels are associated with active lupus nephritis. Archives of Disease in childhood; 2017. Table (1). Comparison between the different studied groups regarding HPSE (ng/ml) Group IActive LN(n=20) Group IINon active LN(n=17) Group IIIActive lupus Without nephritis (n=18) Group IVNon-active lupus Without nephritis(n=15) Group VControl(n=20) F P HPSE (ng/ml) 2.36 ± 0.62 1.44 ± 0.11 1.23 ± 0.07 1.31 ± 0.07 0.29 ± 0.13 115.716 <0.001 p 1 <0.001 <0.001 <0.001 <0.001 Sig.bet.Grps p 2 <0.001 ,p 3 =0.914,p 4 <0.001 ,p 5 =0.719,p 6 <0.001 , p 7 =0.230 F: F for ANOVA test , Pairwise comparison bet. each 2 groups was done using Post Hoc Test (Tukey) − p: p value for comparing between the different groups − p 1 : p value for comparing between group V and each other group − p 2: p value for comparing between group I and group II − p 3: p value for comparing between group III and group IV − p 4 : p value for comparing between group I and group III − p 5 : p value for comparing between group II and group IV − p 6 : p value for comparing between group I and group IV − p 7 : p value for comparing between group II and group III Table 2. Agreement (sensitivity, specificity) for HPSE (ng/ml) to diagnose active lupus nephritis Cut off Sensitivity Specificity PPV NPV HPSE (ng/ml) >1.48 80.0 91.43 72.7 94.1 HPSE (ng/ml) AUC 0.877 p <0.001 95% C.I 0.771 – 0.982 Disclosure of Interests: None declared DOI: 10.1136/annrheumdis-2019-eular.1616Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A231Session: Novel biomarkers in RMDs – next steps towards clinical implementation (Scientific Abstracts)