Doctor of Medicine Dissertation Identification of Lupus Nephritis Risk Biomarkers in Systemic Lupus Erythematosus Patients

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  • Rabu, 26 Juni 2024
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Located in the Hall Room Lt. 4, Postgraduate Building, Udayana University, Denpasar, a Doctoral Promotion examination was held with the promovenda candidate, dr. Ida Ayu Ratih Wulansari Manuaba, Sp.PD-KR, M.Kes, M.H, FINASIM, FINEM, FISQua, with the dissertation title "Enzyme Levels of DNase1, sTNFR1, sTNFR2, sTNFR1 / sTNFR2 Ratio, and Urine Tweak as Risk Factors for Lupus Nephritis in Systemic Lupus Erythematosus Patients." (25/6/2024)


The pathomechanism of Systemic Lupus Erythematosus (LES) disease with the risk of Lupus Nephritis (NL) in some LES patients has not been able to be clearly revealed. The association between decreased DNase1 levels with NETosis and the involvement of the Tumor Necrosis Factor (TNF) cytokine superfamily in the pathomechanism of LES patients with NL is a challenge to be studied further, so that a more complete LES pathomechanism is obtained in proving biomarkers as a risk factor for NL in LES. This study aims to prove low DNase1 levels, sTNFR1, sTNFR2 levels, sTNFR1/sTNFR2 ratios and high urinary TWEAK as risk factors for NL events in LES patients.


This research method uses a case control design in LES patients aged 20-60 years which has been carried out in the Integrated Biomedical Laboratory Unit, Faculty of Medicine, Udayana University, in the period January 2024 to February 2024. The subjects of this study as cases were LES patients with NL, as controls were LES patients without NL. The independent variables were DNase1, sTNFR1, sTNFR2, sTNFR1/sTNFR2 ratio and urine Tweak, and the dependent variable was the incidence of NL. Blood and urine samples were collected directly by the laboratory staff of the Integrated Biomedical Lab unit. Urine DNase1, sTNFR1, sTNFR2 and TWEAK enzyme levels were examined using ELISA method. All data obtained were then analyzed univariate, bivariate and multivarat with SPSS version 25.


There were a total of 44 research subjects, with 22 being cases and 22 being controls. Data on subject characteristics as follows are dominated by women 41 (93.18%) with an age range between 20-60 years. Based on the analysis of risk factors in this study, it was found that there was a significant effect on low DNase1 levels on the incidence of NL in LES patients; while in the analysis of risk factors, it was found that low sTNFR1 levels were significant as a risk factor for the occurrence of NL in LES patients; likewise, the results of the risk factor analysis of low sTNFR2 levels were significant as a risk factor for the occurrence of NL in LES patients. The results of the risk factor analysis did not prove significant for the occurrence of NL in LES patients in the high sTNFr1 / sTNFR2 ratio and have not been proven to be meaningful in high urinary TWEAK levels.


This study proved the effect of low DNase1 levels as a risk factor for NL events in LES patients. In the risk factor analysis, the effect of low STNFR1 and sTNFR2 levels is significant as a risk factor for NL events in LES patients. This study proves that the levels of the sTNFR1 / sTNFR2 ratio are not meaningful and high urine TWEAK has not been proven to be meaningful as a risk factor for NL events in LES patients.



The examination was chaired by the Coordinator of the Doctor of Medicine Study Program, Faculty of Medicine, Udayana University Prof. Dr. dr. I Made Jawi, M.Kes., with a team of examiners:

1. Prof. Dr. dr. Ketut Suryana, Sp.PD-KAI (Promoter)

2. Prof. Dr. dr. I Made Bakta, Sp.PD-KHOM (Copromoter I)

3. Dr. dr. I Made Sudarmaja, M.Kes (Copromoter II)

4. Prof. Dr. dr. I Wayan Putu Sutirta Yasa, M.Si

5. Prof. drh. I Nyoman Mantik Astawa, Ph.D.

6. Prof. Dr. Ir. Ida Bagus Putra Manuaba, M.Phil

7. Prof. Dr.dr.A.A.Wiradewi Lestari, Sp.PK, Subsp.BDKT(K), Subsp KV(K)

8. Dr. dr. Sianny Herawati, Sp.PK, Subsp.BDKT(K), Subsp.NR(K)

9. Dr. dr. Yenny Kandarini, Sp.PD.,KGH

10. Dr. rer. nat. dr. Ni Nyoman Ayu Dewi, M.Si


While academic invitations are :

1. Dr. dr. I Gde Ardika Nuaba, Sp.THT-KL(K), FICS

2. Dr.dr.Made Ratna Saraswati,Sp.PD,KEMD.,FINASIM

3. Dr. dr. I Nyoman Wande, S.Ked.,Sp.PK

4. Dr. dr. Ni Made Renny Anggreni Rena, Sp.PD., KHOM., FINASIM

5. Dr. Apt. I Gusti Ayu Rai Widowati, S.Si.,M.Kes.,MH.,CMC.


In this exam, Dr. dr. Ida Ayu Ratih Wulansari Manuaba, Sp.PD-KR., M.Kes, M.H, FINASIM, FINEM, FISQua, was declared to have graduated as the 419th Doctoral Graduate of the Medical Science Doctoral Study Program, Faculty of Medicine, Udayana University with the title Cumlaude.


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