The neuropeptide adrenomedullin, could it be linked to renal involvement and disease activity in systemic lupus erythematosus?

Aim of the workThe aim of this study was to assess adrenomedullin level in systemic lupus erythematosus (SLE) patients with nephritis compared with those without and healthy controls and to correlate adrenomedullin level with SLE disease activity.Patients and methodsSerum adrenomedullin was evaluated in 60 SLE patients (mean age 27.7 ± 8.25 years) and in 20 matched controls. The SLE patients were divided into two groups: Group I (with nephritis) and Group II (without) (30 patients each). The SLE disease activity index (SLEDAI) was assessed.ResultsThe median serum adrenomedullin levels were significantly higher in SLE patients (7.4 ng/ml) compared to healthy controls (3.1 ng/ml) (p < 0.001). It showed a statistically significant difference between group I (8.8 ng/ml) and II (6.1 ng/ml) (p < 0.01). A significant relation was observed between the level of serum adrenomedullin with the neuropsychiatric manifestations (p = 0.006) and vasculitic lesions (p = 0.014) in group II patients and with pulmonary hypertension (p = 0.04), oral ulcers (p = 0.03), and serositis (p = 0.02) in group I. A significant negative correlation was found in group I patients between adrenomedullin and 24 h protein/day (r = −0.38, p < 0.05), as well as platelets & C4, and with C3 in group II as well as a highly significant correlation between SLEDAI and adrenomedullin level in SLE patients (r = 0.76, p < 0.001) and steroid dose (p < 0.001).ConclusionSerum AM is elevated in SLE especially in lupus nephritis patients & correlates with lupus disease activity. It is negatively associated with urine protein excretion per 24 h in the group of lupus nephritis patients. Serum AM may be considered among biological markers in SLE.