TITLE:
Evaluating Tubuloglomerular Outcome by Measuring Proteinuria and Neutrophil Gelatinase Associated Lipocalin after Induction of Low-Dose Cyclophosphamide among Patients with Class III/IV Lupus Nephritis
AUTHORS:
Md. Shahadut Hossain, Masud Iqbal, Md. Kazi Shahnoor Alam, Md. Masudul Karim, A. K. M. Shahidur Rahman, Mahmudul Hasan Sabuz, Sujon Sarker, Mst Hure Jannat, Muhammad Saiful Islam, Md. Jiaur Rahman, Shahida Islam, Nowshin Taslima Hossain
KEYWORDS:
Euro-Lupus Regimen, Lupus Nephritis (LN), Neutrophil Gelatinase Associated Lipocalin (NGAL), Proteinuria, Tubulo-Glomerular Outcome
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.13 No.7,
July
11,
2025
ABSTRACT: Background: In lupus nephritis (LN), glomerular dysfunction is evident by proteinuria. Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL) has emerged as a promising biomarker to detect tubular dysfunction. Objective: To evaluate the tubulo-glomerular outcome after induction of Euro-Lupus regimen by measuring proteinuria and NGAL. Methods: This was a quasi-experimental study. Patients were included based on American College of Rheumatology (ACR) criteria. A total of 19 diagnosed lupus nephritis (class III & IV with or without class V) cases were evaluated. Their renal biopsy report was labelled according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS). All patients were treated with low-dose cyclophosphamide (Euro-Lupus regimen) for three months. Patients were assessed at baseline and then monthly up to 3 months of induction. The observed major variables were complete blood count (CBC), lupus serology (ANA, anti-dsDNA, C3, C4, anti-phospholipid), 24-hour urinary total protein (UTP), spot urinary protein creatinine ratio (PCR), spot urinary NGAL, urinary NGAL creatinine ratio, serum creatinine, serum albumin and estimated glomerular filtration rate (e-GFR). The activity index (AI), chronicity index (CI) and disease activity over time (SLEDAI) were assessed accordingly. Results: Mean age of the study population was 29 ± 10 years, where 95.5% were female. After 3 months of induction with low-dose cyclophosphamide (Euro-Lupus regimen), hemoglobin, eGFR, and serum albumin level had significantly increased from baseline (p Conclusion: Induction in lupus nephritis by low-dose cyclophosphamide (Euro-Lupus regimen) reduces proteinuria and urinary NGAL significantly after three months of therapy. This regimen is effective in improving glomerular and tubular dysfunctions of LN.