A urinary tenascin-C biomarker score predicts long-term kidney function in lupus nephritis

Various criteria for proteinuria are used in clinical trials for lupus nephritis. Still, they do not always correlate with long-term preservation of kidney function because they do not account for the disease's inflammatory component. A urine-based proteomic score using tenascin-C and other protein biomarkers accurately predicted long-term kidney function loss, independent of proteinuria criteria.

Dr Andrea Fava (Johns Hopkins University, MD, USA) presented results from an Accelerating Medicines Partnership study in patients with lupus nephritis, followed for a median of 4.9 years (maximum 7.8 years) [1]. Around 1,200 urinary biomarkers were analysed and compared with kidney biopsy data to determine the risk of eGFR decline (≥40%).

In total, 170 patients were followed up and divided into those with stable eGFR (69%) and those with a sustained eGFR decline of ≥40% (31%). Multiple biomarkers, including inflammatory and fibrosis-associated markers, were associated with sustained eGFR loss at 3, 6, and 12 months, with tenascin-C showing the highest hazard ratio for kidney function loss. A protein-based predictive score (tenascin-C plus 10 other urinary proteins) was developed to stratify patients into high- and low-risk groups for eGFR loss. This classification was significantly associated with eGFR loss (P<0.0001), both in patients considered responders (<0.5 mg/mg) and non-responders (≥0.5 mg/mg) by proteinuria criteria.

“We found that tenascin-C predicts kidney function loss in lupus nephritis,” concluded Dr Fava. “The proteomic score outperforms proteinuria and helps stratify patients regardless of the current definition of response. These findings provide insight into the disease's mechanistic aspects and support the development of biomarkers to personalise treatment. Clinical trial endpoints and response definitions should be selected among biomarkers most strongly associated with eGFR protection.”

1. Lee CY, et al. Urinary tenascin C predicts kidney function loss in lupus nephritis. ACR Convergence, 24–29 October 2025, Chicago, IL, USA.

Medical writing support was provided by Mihai Surducan, PhD.

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Posted on 29 October 202529 October 2025