Systemic lupus erythematosus: Morphologic correlations with immunologic and clinical data at the time of biopsy

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The findings in 77 biopsy specimens from 59 patients with systemic lupus erythematosus were compared with the immunologic data gathered at the time of biopsy. The biopsy specimens were classified by a number of morphologic parameters in an attempt to see which classification offered the best correlation with the immunologic data. These parameters included: (1) over-all amount of deposits of immunofluorescence; (2) distribution of deposits on immunofluorescence; (3) amount and distribution of glomerular proliferative lesions; (4) classification of Baldwin et al. The best correlations were obtained with the over-all amount of deposits or with a classification based upon their distribution. Correlations with glomerular proliferative lesions or with the standard classification based upon these proliferative lesions were poorer. Excellent correlations were obtained between increasing morphologic lesions and increasing levels of DNA-binding, and decreasing concentrations of the third component of complement (C3). Somewhat broader and poorer correlations were also found with increasing antinuclear antibody and lupus erythematosus cell positivity, decreasing levels of the fourth component of complement (C4) and diminished titers of thymic hormone. Immune complexes, as detected by the polyethylene glycol (PEG) method, were present in the vast majority of untreated patients with renal immune deposits, but treatment suppressed PEG positivity in the majority of such patients. Rheumatoid factor and cryoglobulins showed an interesting relationship to one another, in that rheumatoid factor was confined to the patients with milder lesions and cryoglobulins largely to the patients with more severe lesions; no patient in our series was positive for both simultaneously. There was no correlation between the levels of immunoglobulins or of T and B lymphocytes, and the severity of morphologic lesions, although there were significant differences in these parameters between treated and untreated patients. Excellent correlations were also found with the following clinical parameters: serum creatinine and urea, level of hematuria, level of proteinuria and presence of hypertension. These tended to substantiate the validity of the correlations with the immunologic data. Results for creatinine clearance were more erratic.