• Hijab Batool Central Park Medical College, Lahore.
  • Tahira Naseem Sheikh Zayed Hospital Lahore
  • Marium Shoukat CMH Multan Institute of Medical science


Background: The most common complication of SLE is lupus nephritis (LN) causing high morbidity and mortality. The routine biomarkers used for the diagnosis of LN do not have the ability to predict the worsening in renal disease activity. Thus, there is need of a new biomarker leading to detection of flare in LN. The objective of this study was to assess the role of urinary neutrophil gelatinase associated lipocalin (uNGAL) as a predictor of renal flare in patients with lupus nephritis. Methods: Including a total of 84 subjects, 42 cases were lupus patients without renal involvement and 42 cases were lupus patients with nephritis (24 active nephritis and 18 inactive nephritis). The diagnosis of lupus nephritis was established on the basis of renal biopsy. uNGAL was estimated in both groups. Results: This study revealed that the nephritis group had increased levels of uNGAL as compared to systemic erythematosus patients without having lupus nephritis (p-value <0.05). Patients with active nephritis had increased uNGAL levels as compared to patients with inactive nephritis. Conclusion: From the findings in our study, it can be stated that uNGAL can prove to be a noninvasive, reliable and sensitive biomarker to predict flare in cases of lupus nephritis. Keywords: Neutrophil Gelatinase Associated Lipocalin; systemic lupus erythematosus; Lupus nephritis; Biomarker; Renal Disease Activity; Flare

Author Biographies

Hijab Batool, Central Park Medical College, Lahore.

Assistant Professor. Department of Pathology. Central Park medical College, Lahore.

Tahira Naseem, Sheikh Zayed Hospital Lahore

Associate Professor of Chemical Pathology,Departemnt of biochemistry and Chemical pathology. Sheikh Zayed Hospital Lahore,

Marium Shoukat, CMH Multan Institute of Medical science

Asst. prof. biochemistry. Deoartment of Biochemistry. CMH Multan Institute of Medical science


Torres-Salido M, Cortes-Hernandez J, Vidal X, Pedrosa A, Vilardell-Tarres M, Ordi-Ros J. Neutrophil gelatinase-associated lipocalin as a biomarker for lupus nephritis. Nephrology Dialysis Transplantation. 2014;29(9):1740-1749.

Mok CC. Biomarkers for lupus nephritis: a critical appraisal. J Biomed Biotechnol. 2010;638413:11.

Fiehn C. Early diagnosis and treatment in lupus nephritis: how we can influence the risk for terminal renal failure. J Rheumatol. 2006; 33:1464-1466.

Phan T, Toong C, Adelstein S. Clearing the complexity: immune complexes and their treatment inlupus nephritis. IJNRD. 2011;17.

Weening J, D'Agati V, Schwartz M, Seshan S, Alpers C, Appel G et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int. 2004;65(2):521-530.

Rosner MH (2009) Urinary biomarkers for the detection of renal injury. AdvClinChem 49: 73-97.

Cameron JS. Lupus nephritis. J Am SocNephrol. 1999;10:413–424.

Mok C. Biomarkers for Lupus Nephritis: A Critical Appraisal. Journal of Biomedicine and Biotechnology. 2010;2010:1-11

Zickert A, Sundelin B, Svenungsson E, Gunnarsson I. Role of early repeated renal biopsies in lupus nephritis. Lupus Science & Medicine. 2014;1(1):e000018-e000018

Hinze C, Suzuki M, Klein-Gitelman M, Passo M, Olson J, Singer N et al. Neutrophil gelatinase-associated lipocalin is a predictor of the course of global and renal childhood-onset systemic lupus erythematosus disease activity. Arthritis Rheum. 2009;60(9):2772-2781

Xu S, Venge P. Lipocalins as biochemical markers of disease. Biochim BiophysActa 2000; 1482: 298 – 307.

Bolignano D, Lacquaniti A, Coppolino G, Donato V, Campo S, Fazio MR et al. Neutrophil Gelatinase Associated Lipocalin and progression of chronic kidney disease. Clin J Am SocNephrol 2009; 4(2): 337 – 44.

Mori K, Nakao K. Neutrophil Gelatinase Associated Lipocalin as the real-time indicator of active kidney damage. Kidney Int 2007; 71: 967 – 70.

Brunner HI , Mueller M, Rutherford C, Passo MH, Witte D, Grom A, et al. Urinary neutrophil gelatinase associated lipocalcin as a biomarker of nephritis in childhood onset systemic lupus erythmatosus. Arthritis Rheum 2006; 54:2577-84.

Hinze CH, Suzuki M, Klein-Gitelman M. Neutrophil gelatinase associated lipocalcin is a predictor of the course of global and renal childhood onset systemic lupus erythmatosus disease activity. Arthritis rheum 2009; 60:2772-81.

Systemic lupus erythematosus disease activity index 2000.Gladman DD, Ibañez D, Urowitz MB. J Rheumatol. 2002 Feb; 29(2):288-91.

Eman M. I. Youssef et al.: Study of Urinary Neutrophil Gelatinase Associated Lipocalin-2(uNGAL) as a Marker in Renal Disease Activity with Systemic Lupus Erythematosis (Lupus Nephritis). American Journal of Medicine and Medical Sciences 2015, 5(4): 158-163 .

Elwa E, El Tokhy M, Fathy S, Talaat A. Predictive role of urinary neutrophil gelatinase associated lipocalin in lupus nephritis. Lupus 2014;24(2):138-146.

Zeinab H. El Sayed, Samia T. Ali , Amany K. Mohamed, Nagwa A. Mohamed2, Zeinab A. Yousry, Waganat E. El Sayed .Predictive Role of Plasma Neutrophil Gelatinase-associated Lipocalin and IL-18 in Lupus nephritis. International Journal of Advanced Research (2015), Volume 3, Issue 1, 912-922

Norella CT Kong S. Urine Neutrophil Gelantinase Associated Lipocalin(uNGAL) in Lupus Nephritis: A Prospective Longitudinal Study. J Clin Cell Immunol 2014;05(03).

Rubinstein T, Pitashny M, Levine B, Schwartz N, Schwartzman J, Weinstein E et al. Urinary neutrophil gelatinase associated lipocalin as a novel biomarker for disease activity in lupus nephritis. Rheumatology. 2010;49(5):960-971.

Torres-Salido, M., Cortes-Hernandez, J., Urquizu-Padilla, M., Pedrosa, A., Balada, E., Vilardell-Tarres, M., et al; Neutrophil Gelatinase-Associated Lipocalin (NGAL) as a Urinary Biomarker of Disease Activity and Severity in Lupus Nephritis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :927

Suzuki M, Wiers K, Klein – Gitelman M, Haines KA, Olson J, Onel K et al. Neutrophil Gelatinase Associated Lipocalin as a biomarker of disease activity in pediatric lupus nephritis. PediatrNephrol 2008; 23: 403 – 12.