article · The Egyptian Journal of Internal Medicine
Lupus nephritis complicated by thrombotic microangiopathy is a severe kidney condition involving inflammation and microvascular injury. A longitudinal study evaluated serum S100 calcium-binding protein P, known as S100P, in 100 systemic lupus erythematosus patients with this renal phenotype alongside 50 healthy controls over 12 months. Baseline serum S100P concentrations were significantly higher in patients than in healthy individuals, though initial levels did not correlate with overall disease activity scores or kidney biopsy indices. Over the 12-month period, circulating S100P levels dropped substantially in patients who achieved partial or complete renal response compared to nonresponders. Longitudinal changes in S100P concentrations tracked with shifts in standard indicators, such as creatinine, lactate dehydrogenase, and complement proteins. Consequently, S100P represents a promising complementary biomarker for tracking treatment response, though broader validation in multicentre cohorts is needed.
Lupus nephritis with thrombotic microangiopathy is a severe kidney complication of systemic lupus erythematosus that requires close clinical tracking. Identifying blood markers that reflect treatment response helps clinicians understand whether a patient is recovering. Monitoring S100P alongside conventional laboratory tests could offer medical teams an additional tool to track therapeutic progress and identify patients who are failing to respond to therapy.
This research represents early-stage biomarker identification that could eventually inform the development of clinical monitoring assays or diagnostic kits for nephrologists and rheumatologists. The abstract indicates the marker is currently a candidate requiring validation in larger multicentre cohorts and appropriate disease-control groups. It is therefore at an early stage of clinical translation, several steps removed from commercial diagnostic use, and does not yet demonstrate disease specificity or pretreatment predictive utility.
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Abstract Purpose Lupus nephritis (LN) complicated by thrombotic microangiopathy (TMA) represents a severe renal phenotype characterized by immune-mediated inflammation and microvascular injury. S100 calcium-binding protein P (S100P) participates in inflammatory and stress-related signaling, providing a biological rationale for evaluating its potential as a circulating biomarker in LN-TMA. Methods In this single-center longitudinal biomarker study nested within an observational cohort, 100 patients with systemic lupus erythematosus (SLE) and biopsy-confirmed proliferative LN (ISN/RPS class III or IV) with concomitant TMA were evaluated together with 50 age- and sex-matched healthy participants included for baseline biomarker comparison. Serum S100P was measured at baseline and at 6 and 12 months, and longitudinal changes were examined in relation to renal response, conventional laboratory parameters, SLEDAI-2 K, and renal histopathological indices. Results Baseline serum S100P was markedly higher in patients with LN-TMA than in healthy participants [median 21.3 (IQR 19.1–24.0) versus 0.1 (0.1–1.0) ng/mL; P < 0.001]. Baseline S100P was not significantly associated with SLEDAI-2 K or renal biopsy activity and chronicity indices. At 6 months, partial responders had lower S100P concentrations than nonresponders [8.5 (7.6–9.2) versus 12.4 (8.6–23.2) ng/mL; P = 0.004; AUC = 0.811]. At 12 months, complete responders had substantially lower concentrations than nonresponders [7.5 (6.7–8.4) versus 27.3 (24.3–29.3) ng/mL; P < 0.001; AUC = 0.967]. Longitudinal S100P changes were associated with changes in creatinine, lactate dehydrogenase, C3, and C4. Conclusion In this single-center LN-TMA cohort, serum S100P was markedly elevated compared with healthy participants and declined substantially among patients achieving renal response. These findings support an association between longitudinal S100P changes and treatment response but do not establish disease specificity or pretreatment predictive value. S100P should therefore be considered a candidate complementary monitoring biomarker requiring validation in larger multicenter cohorts with appropriate disease-control groups.
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DOI: 10.1186/s43162-026-00709-9
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