Assessment of Urinary TNF-like Weak Inducer of Apoptosis as a Marker of Lupus Nephritis

Elnagar, Rasha M.; Al-Noman, Hifaa G.; Al-Rashidi, Hanan E.; Elzayady, Mohamed M.; Eleraky, Elshimaa S.; Elageery, Safaa M.; Gouda, Nawal S.; Selim, Mariam; Alahmadi, Sofanah A.; Talaat, Rania

doi:10.21608/ejmm.2025.384757.1639

Assessment of Urinary TNF-like Weak Inducer of Apoptosis as a Marker of Lupus Nephritis

Document Type : New and original researches in the field of Microbiology.

Authors

¹ Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; Basic Medical Sciences Department, College of Medicine, AlMaarefa University, Riyadh, 11597 Saudi Arabia

² Nogoud Medical Center, Almadinah Almonawarah, Ministry of Health, Saudi Arabia

³ Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, Taibah University, Saudi Arabia

⁴ Internal Medicine Department, Faculty of Medicine, Mansoura University

⁵ Internal Medicine Department, Faculty of Medicine, Horus University, Egypt

⁶ Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Egypt

⁷ Microbiology Department, Faculty of Medicine, Northern Border University, Ar,ar, Saudi Arabia

⁸ Mansoura Manchester Medical Program, Faculty of Medicine, Mansoura University, Egypt

⁹ Al-Rayan College of Medicine, Almadinah Almonawarah, Saudi Arabia

¹⁰ Medical Microbiology and Immunology Department, Faculty of Medicine, Helwan University

10.21608/ejmm.2025.384757.1639

Abstract

Background: TNF-related weak inducer of apoptosis (TWEAK) is a proinflammatory cytokine that may play a major role in the pathophysiology of lupus nephritis (LN). Aim: We investigated the correlation between LN and urinary TWEAK and its use as a biomarker in LN. Methodology: This study comprised 56 females with systemic lupus erythematosus (SLE) and 56 age-matched healthy female controls. Patients were grouped into 27 patients with non-renal SLE and 29 with LN. The LN group was also categorized into patients with active renal disease (n=19) and inactive renal disease (n=10). Urinary TWEAK was measured in all participants using ELISA. Results: The LN group had markedly elevated urinary TWEAK levels compared to non-renal SLE, inactive LN, and normal controls. Significant positive associations were observed between urinary TWEAK and tSLEDAI (P< 0.001), as well as rSLEDAI (P< 0.001). Negative associations were identified between urinary TWEAK and C3 and C4 (P< 0.001). Urinary TWEAK levels exhibited a positive correlation with elevated kidney biopsy grades (P< 0.001). The threshold values for urinary TWEAK were >2.06 for SLE, >5.91 for LN, and >6.5 for active LN, with corresponding sensitivity rates of 100%, 75.86%, and 84.21%, respectively. The specificity rates were 94.74%, 88.89%, and 70%, respectively. The positive and negative predictive values augmented the importance of urine TWEAK. The accuracy rates were 97.3% for SLE, 82.1% for LN, and 79.3% for active LN. Conclusion: Urinary TWEAK demonstrated a positive correlation with the activity parameters of LN, indicating its potential role as a marker for monitoring renal involvement and disease activity.

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