Exosomal miR-146a was found to be strongly associated with changes in proteinuria and lupus activity.Exosomal miR-146a was able to identify LN patients with an AUC of 0.81 (sensitivity = 67%, specificity = 88%, p < 0.001) and detected flares in LN patients with an AUC of 0.88 ± 0.055 (p < 0.0001).An in vitro examination revealed that LPS stimulation caused a significant increase of miR-146a levels, TRAF6 and IRAK1 mRNA expression (p < 0.05). Here, IRAK1 is linked to lobular neoplasia.