Urinary Biomarkers as a Tool for Monitoring Remissions and Predicting Relapses in Autoimmune Glomerulonephritis
Bibliographic record
Abstract
Background: Complement-mediated injury, inflammation and fibrosis play central roles in the pathogenesis of autoimmune glomerulonephritis. The use of urinary biomarkers as a surrogate of these pathways of injury could assist clinicians during the clinical follow-up. We investigated the value of urinary biomarkers of complement activation, inflammation and fibrosis during periods of sustained remission among patients with autoimmune glomerulonephritis. Methods: We prospectively examined 100 patients with ANCA-associated vasculitis, focal segmental glomerulosclerosis, IgA nephropathy, lupus nephritis, membranoproliferative glomerulonephritis and membranous nephropathy. Proteinuria, urinary sC5b-9, monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor-β1 (TGF-β1), expressed as creatinine ratios, were measured at presentation and during follow-up visits. We used standard definitions of remission and relapse for each type of glomerulonephritis. Wilcoxon signed-rank test was used to compare changes in urinary biomarkers during remissions and relapses. Results: We identified 95 periods of active disease and 82 episodes of sustained remission. Inactive periods lasted a median of 22 (11-32) months. Eighty percent (n=66) of these were not followed by a relapse. During these episodes of remission, urinary biomarkers continued to steadily decrease, achieving a reduction of 40% for proteinuria, 40% for urinary sC5b-9, 38% for MCP-1 and 40% for TGF-β1 (all p < 0.05). Twenty percent (n=16) of inactive periods reflected remissions with subsequent relapses. Biomarker levels during the inactive period preceding relapses did not significantly change for proteinuria (+8%), urinary sC5b-9 (+15%) and MCP-1 (4%), while they decreased for TGF-β1 (-30%, p=0.02). During relapses, we observed a 3.2-fold (1.9-8.3) increase in proteinuria and a significantly greater 8.5-fold (4.2-56.9) increase in urinary sC5b-9 (p=0.001). By contrast, urinary MCP-1 and TGF-β1 increased significantly less than proteinuria. Conclusions: Failure to achieve a sustained reduction in urinary biomarkers during remission was associated with a subsequent risk of relapse of autoimmune glomerulonephritis. Urinary sC5b-9 appears to be a more discerning marker of immunological relapse. Funding: Private Foundation Support
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".