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

• Published in: Journal of nephrology Vol. 37; no. 8; pp. 2243 - 2253
• Main Authors: Hernández-Andrade, Adriana, Nordmann-Gomes, Alberto, Juárez-Cuevas, Bernardo, Zavala-Miranda, Maria Fernanda, Cruz, Cristino, Mejía-Vilet, Juan M.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.11.2024
• Subjects: Adult; Aged; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - complications; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - physiopathology; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - urine; Biomarkers - urine; Creatinine - urine; Epidermal Growth Factor - urine; Female; Glomerular Filtration Rate; Glomerulonephritis - complications; Glomerulonephritis - diagnosis; Glomerulonephritis - physiopathology; Glomerulonephritis - urine; Humans; Kidney - physiopathology; Lupus Nephritis - complications; Lupus Nephritis - diagnosis; Lupus Nephritis - physiopathology; Lupus Nephritis - urine; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Original Article; Predictive Value of Tests; Prognosis; Recovery of Function; Renal Replacement Therapy; Severity of Illness Index; Time Factors; Urology; Glomerulonephritis; Epidermal growth factor; Lupus nephritis; ANCA vasculitis; uEGF/Cr
• DOI: 10.1007/s40620-024-02068-6
• ISSN: 1724-6059

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/1.73m 2 ): 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/1.73m 2 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/1.73m 2 . 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. Graphical abstract