Urine levels of soluble CXCL16 are increased in patients with lupus nephritis or renal allograft rejection.53,54 Macrophage migration inhibitory factor (MIF) is a molecule that is produced at sites Tanespimycin molecular weight of inflammation and inhibits further macrophage migration in response to chemokines, thereby allowing macrophages to accumulate at the inflammatory site. MIF can also enhance the activity of macrophages and T cells at sites of injury. Increasing levels of MIF in urine correlate with kidney leukocyte accumulation and the severity of renal damage in proliferative forms of glomerulonephritis.55 In addition, elevated

MIF levels in urine can predict episodes of acute renal allograft rejection and discriminate from cyclosporine nephrotoxicity.56 There are also other pro-inflammatory mediators that can indentify inflammation in the injured kidney. Vascular cell adhesion molecules-1 (VCAM-1) is expressed by renal vessels and some kidney cells during renal inflammation and facilitates transendothelial leukocyte migration. Some of this VCAM-1 is enzymatically cleaved Buparlisib supplier and excreted into the urine. Urine levels of soluble VCAM-1 are

elevated during active periods of anti-nuclear cytoplasmic antibody vasculitis and lupus nephritis,53,57 and are useful for determining the severity and type of renal allograft rejection.58 Interleukin-18 (IL-18) is a pro-inflammatory cytokine that is produced by leukocytes, vessels and kidney tubules. During acute renal injury, there is a substantial increase in IL-18 production by tubules. Elevated urine levels of IL-18 are a relatively sensitive and specific marker of acute tubular necrosis (ATN) and delayed graft function in the post ischaemic kidney.59 Urine levels also correlate with disease activity in idiopathic

nephritic syndrome.60 Tumour necrosis factor receptor-1 (TNFR1) is one of the major receptors for the pro-inflammatory cytokine TNF-α, which is expressed on infiltrating leukocytes and some learn more resident kidney cells during renal inflammation. The soluble form of TNFR1 is more stable and easier to detect in serum and urine than TNF-α and it can serve as a surrogate marker of TNF-α activity in kidney disease. Serum and urine levels of soluble TNFR1 are increased during acute and chronic renal inflammation and correlate with the progression of acute renal failure, lupus nephritis and diabetic nephropathy.50,53,61 Another recent inclusion to this family of biomarkers is soluble human leukocyte antigen-DR. Urine levels of soluble human leukocyte antigen-DR are a sensitive and highly specific marker of acute renal allograft rejection, which can be detected up to 5 days before the clinical signs of acute cellular or vascular rejection are evident.62 The development of renal fibrosis is dependent on excessive production of profibrotic growth factors and extracellular matrix, which can be detected in urine by ELISA.