A Liquid Biopsy for Lupus Nephritis?

TR: What impact do you think a liquid biopsy will have on rheumatology?

Dr. Fava: As a humble rheumatologist, I’m not trying to compare myself to a cardiologist. But if you think about cardiology, every few decades they completely change management paradigms thanks to the development of a new assay. For example, the echocardiogram came out, and now congestive heart failure has become heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF). A lot of the management strategy depends on using ejection fraction as a biomarker. I think the liquid biopsy in lupus nephritis may behave in the same way.

TR: Are there any partners you’d like to acknowledge who helped make your work a reality?

Dr. Fava: Our work is the product of the Accelerating Medicines Partnership, a wonderful consortium in which the U.S. National Institutes of Health, industry and academia come together to revolutionize the ways we do discovery. The Lupus Research Alliance has made the development of clinically useful biomarkers a priority for the next few years, and we really praise their effort in bringing the community together to accelerate development. I’d also like to acknowledge all the patients and their families who have participated and continue to contribute to this research

In Summary

Although still in the research stage, the liquid biopsy holds promise as a noninvasive means of detecting lupus nephritis early, distinguishing active disease from chronic damage and tailoring therapy for our patients. If we can better monitor and control inflammation, we can better save kidneys.

Also, if you missed Dr. Fava’s Plenary session at ACR Convergence 2025, be sure to catch it OnDemand.

Samantha C. Shapiro, MD, is a clinician educator who is passionate about the care and education of rheumatology patients. She writes for both medical and lay audiences and practices telerheumatology.

References

1. Fava A, Buyon J, Magder L, et al. Urine proteomic signatures of histological class, activity, chronicity and treatment response in lupus nephritis. JCI Insight. 2024 Jan 23;9(2):e172569.
2. Fava A, Rao DA, Mohan C, et al. Urine proteomics and renal single-cell transcriptomics implicate interleukin-16 in lupus nephritis. Arthritis Rheumatol. 2022 May;74(5):829–839.
3. Fava A, Concoff A, O’Malley T, et al. A urinary biomarker panel to predict the probability of histologically active lupus nephritis [abstract: 1642]. Arthritis Rheumatol. 2024 Oct; 76 (suppl 9).
4. EE C, Taghavi S, Zhang S, et al. Urinary tenascin C predicts kidney function loss in lupus nephritis [abstract: 0851]. Arthritis Rheumatol. 2025 Oct; 77(suppl 9).
5. Fava A, LEE C, Guthridge C, et al. Association of urinary biomarkers with histological features in diagnostic and per-protocol repeat kidney biopsies in lupus nephritis [abstract: 0842]. Arthritis Rheumatol. 2025 Oct; 77(suppl 9).
6. LEE C, Lu R, Guthridge C, et al. Urinary biomarkers detect proliferative lupus nephritis in SLE patients with subclinical proteinuria [abstract: 1480]. Arthritis Rheumatol. 2025 Oct; 77(suppl 9).