A simple urine test may soon change how doctors monitor kidney disease in people with lupus, potentially replacing painful and risky kidney biopsies.
Researchers led by Dr. Chandra Mohan at the University of Houston have discovered that certain proteins found in urine can accurately reveal signs of lupus-related kidney damage.
Lupus, or systemic lupus erythematosus (SLE), is an autoimmune disease that causes the body’s immune system to attack its own tissues and organs.
About 5 million people around the world live with lupus, and up to half of them develop lupus nephritis, a severe kidney complication that can lead to kidney failure and death.
Between 5% and 25% of patients with lupus nephritis die from kidney-related causes within just five years of diagnosis.
Currently, doctors rely on renal biopsies—invasive procedures that remove a small piece of kidney tissue for analysis—to diagnose and monitor the disease.
While effective, biopsies are painful, expensive, and carry risks of bleeding or infection. They also depend on human interpretation, which can vary between pathologists.
“Renal biopsy is invasive and inconvenient, and its results are often subjective,” said Dr. Mohan, a leading lupus researcher and the Hugh Roy and Lillie Cranz Cullen Endowed Professor of Biomedical Engineering at the University of Houston. “We urgently need noninvasive biomarkers that can reliably track disease activity.”
To meet this need, Mohan’s team analyzed 1,317 urine samples from people with lupus nephritis, collected at the same time as their kidney biopsies.
Using a technique called proteomics, which studies all the proteins present in a sample, the researchers identified 57 proteins that were significantly higher in patients whose kidneys showed more active damage.
When viewed under a microscope, these elevated proteins were linked to key signs of injury, such as swelling of blood vessel cells, tissue death, and clusters of damaged immune cells in the kidneys.
Many of the proteins came from immune cells, suggesting that inflammation was driving the kidney damage.
Other proteins were tied to long-term scarring, showing that the urine test could potentially measure both current inflammation and chronic damage.
“By analyzing proteins in urine, we can tell how active or long-lasting someone’s lupus-related kidney disease is—without having to do another biopsy,” Mohan explained.
The study, published in the Journal of Clinical Investigation, offers hope for millions of lupus patients who undergo repeated biopsies to monitor their kidney health.
A urine-based test could make disease tracking faster, safer, and more comfortable—helping doctors personalize care and intervene earlier to protect kidney function.
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