単純な尿検査によるループス腎炎の非侵襲的診断(Simple Urine Test Could Transform Kidney Care)

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2025-10-21 ヒューストン大学(UH)

ヒューストン大学のチャンドラ・モハン教授らは、ループス腎炎(LN)を非侵襲的に診断・モニタリングできる尿中バイオマーカー群を特定した。研究チームは腎生検時に採取した1,317検体をプロテオミクス解析し、腎障害の活動性と関連する57種類の尿タンパク質を同定。これらの多くは免疫細胞由来で炎症や線維化に関与していた。尿タンパク質レベルの測定により、病理的変化を再現的に反映し、繰り返しの侵襲的生検を回避できる可能性が示唆された。研究成果は『Journal of Clinical Investigation』に掲載され、ループス患者5億人のうち半数が腎疾患を抱える現状を踏まえ、世界的な腎ケア改善に寄与することが期待される。

<関連情報>

尿タンパク質は、急性ループス腎炎と慢性ループス腎炎の根底にある異なる凝固および補体カスケードを明らかにする Urine proteins reveal distinct coagulation and complement cascades underlying acute versus chronic lupus nephritis

Ting Zhang, Jessica Castillo, Anto Sam Crosslee Louis Sam Titus, Kamala Vanarsa, Vedant Sharma, Sohan Kureti, Ramesh Saxena, and Chandra Mohan
The Journal of Clinical Investigation  Published: October 1, 2025
DOI:https://doi.org/10.1172/JCI186143

単純な尿検査によるループス腎炎の非侵襲的診断(Simple Urine Test Could Transform Kidney Care)

Abstract

The current gold standard for assessing renal pathology in lupus nephritis (LN) is invasive and cannot be serially repeated. To assess if urine can serve as a liquid biopsy for underlying renal pathology, urine obtained from patients with LN at the time of renal biopsy were interrogated for 1,317 proteins, using an aptamer-based proteomic screen. Levels of 57 urine proteins were significantly elevated and correlated with pathology activity index (AI), notably endocapillary hypercellularity, fibrinoid necrosis, and cellular crescents. These included proteins pertaining to leukocyte/podocyte activation, neutrophil activation, endothelial activation, and markers of inflammation/anti-inflammation. In contrast, complement and coagulation cascade proteins, and proteins related to the extracellular matrix (ECM) emerged as the strongest urinary readouts of concurrent renal pathology chonicity index (CI), notably tubular atrophy and interstitial fibrosis. In vitro mechanistic studies revealed that complement proteins C3a and C5a increased the expression of profibrotic ECM proteins in macrophages and proximal tubule epithelial cells. Thus, carefully assembled panels of urinary proteins that are indicative of high renal pathology AI and/or CI may help monitor the status of renal pathology after therapy in patients with LN, in a noninvasive manner, without the need for repeat renal biopsies.

医療・健康
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