The role of trefoil factor-3 in the evaluation of renal alteration in patients with ankylosing spondylitis

Kidney damage in ankylosing spondylitis (AS) id observed rather often. The diagnostic value of traditional markers of renal damage is not high that often leads to delayed diagnosis. Therefore, an active search for alternative methods is desirable. The aim: to assess the state of tubulointerstitium in patients with ankylosing spondylitis by measuring the level of urinary excretion of trefoil factor-3 (TFF-3). Patients and methods: urine samples of 50 patients (male/female - 37/13) were evaluated. The requirements for patients providing samples were: confirmed diagnosis of AS, age 18 and over and the absence of intercurrent diseases. Median age of patients was 39 [34; 56] years, duration of articular syndrome was 10 [7; 18] years, glomerular filtration rate (GFR) was 105 [83; 119] ml/min/1.73 m2. Patients received nonsteroidal anti-inflammatory drugs (NSAIDs), Disease Modifying Anti-Rheumatic Drugs (DMARDs) and tumor necrosis factor alpha inhibitors (TNFα inhibitors). TFF-3 level was measured by enzyme-linked immunosorbent assay. Urinary excretion was expressed as nanograms per mmol of urinary creatinine. The results were compared with the results of the control group. Results: the level of TFF-3 in patients without chronic kidney disease (CKD) was higher than in the control group: 53.4 [20.8; 105.7] vs. 23.3 [1.9; 62.9] ng/mmol respectively (р=0.02). A correlation with disease activity was found for BASDAI (rs=0.3, р<0.05) and ASDAS (rs=0.3, р<0.05). Marker values in patients receiving NSAIDs were higher compared with other type of therapy: 89.5 [39.8; 118.9] and 32.6 [13.5; 88.2] ng/mmol respectively (р=0.04). The level of TFF-3 did not depend on sex, age and AS duration. It also did not correlate with GFR and albuminuria. Conclusions: TFF-3 urinary excretion was higher in patients with AS compared with healthy individuals, as well as in patients receiving NSAIDs compared with TNFα inhibitors. Thus, the marker may be of interest for diagnosis in patients with pre-clinical tubulointerstitial damage, including those associated with the NSAIDs toxicity.

анкилозирующий спондилит, хроническая болезнь почек, фактор трилистника-3, ankylosing spondylitis, chronic kidney disease, trefoil factor-3

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