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The Renal Activity Index for Lupus: Validation for Prediction of Kidney Inflammation in Adult Patients With Lupus Nephritis
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DOI：10.3899/jrheum.2025-0504.png)
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Abstract
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Objective To evaluate the ability of the Renal Activity Index for Lupus (RAIL) score, a urine biomarker-derived score, to capture and predict the course of active LN in adult patients. Methods Available serial urine samples collected up to week 52 from a subset of adults with active biopsy-proven proliferative LN participating in the double-blind randomized ALLURE trial of abatacept (NCT01714817) were used to calculate RAIL-scores from creatinine-adjusted urine biomarkers (NGAL, KIM-1, MCP-1, adiponectin, hemopexin, ceruloplasmin). Discriminative performance of RAIL-scores alone over time were compared with urine protein-to-creatinine-ratio (UPCR), kidney function (eGFR), and mixed model analysis of RAIL-score adjusted for baseline UPCR, eGFR, age, weight, sex, and race (RAIL-adjBL), with comparisons by renal response states including complete renal response (CRR), partial renal response but not CRR (PRR-only), and non-response (NR). Results The analysis included 240 patients who contributed 599 samples. At weeks 12/24/52 there were 44/22/15 patients with PRR-only, 27/33/18 with CRR, and 127/61/15 with NR. RAIL-scores, eGFR, and UPCR improved over time, irrespective of abatacept use but were significantly lower with CRR compared to NR. The eGFR alone had poor accuracy [area under the receiver operating characteristic curve (AUC) <0.51] to discriminate renal response. Only after correction of baseline UPCR and eGFR, the RAIL-score had excellent accuracy to reflect CRR from other renal response states at the current (AUC=0.83-0.84) and next visit (AUC=0.84-0.85) and performed better than UPCR; without correction UPCR and RAIL-score had similarly good accuracy. Conclusion RAIL-scores identify active LN and longitudinally predict the course of adult LN.
Keywords:
biomarkers
lupus nephritis
systemic lupus erythematosus
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