The value of a panel of autoantibodies for predicting the activity of lupus nephritis at time of renal biopsy.

Gabriella Moroni,Francesca Raffiotta,Barbara Trezzi,Antonella Radice,Silvana Quaglini,Piergiorgio Messa,Renato Alberto Sinico

doi:10.1155/2015/106904

Abstract

Few studies have correlated serum biomarkers with renal histology, the gold standard for renal activity, in lupus nephritis (LN). We tested a panel of autoantibodies and complement at the time of kidney biopsy and after treatment. Anti-dsDNA, anti-nucleosome, anti-ribosome P, and anti-C1q antibodies and C3/C4 were measured in 107 patients with LN at the time of renal biopsy and after 6–12 months and were correlated with clinical/histological parameters. At multivariate analysis, high titers of anti-C1q antibodies or of anti-dsDNA antibodies (P = 0.005, OR = 8.67, CI: 2.03–37.3) were the independent predictors that discriminate proliferative from nonproliferative LN. All the immunological parameters, except anti-ribosome, showed a significant correlation with activity index but not with chronicity index. Only anti-C1q showed a significant correlation with the amount of proteinuria (R = 0.2, P = 0.03). None of the immunological parameters were predictive of remission at 6 and 12 months. We found that anti-C1q alone or in combination with anti-dsDNA emerged as the most reliable test in differentiating proliferative and nonproliferative LN. Anti-C1q was the only test correlated with the clinical presentation of LN. After treatment, the titre of the autoantibodies was significantly reduced, but none was predictive of remission.

Highlights

Lupus nephritis (LN) is one of the most frequent manifestations of Systemic Lupus Erythematosus (SLE) and represents a major determinant of disease morbidity and mortality [1]
In our previous paper on a large cohort of SLE patients evaluated prospectively for 6 years, we demonstrated that renal exacerbations seem to be quite improbable in the presence of normal values of C3, C4, anti-dsDNA, anti-C1q, and that anti-C1q was slightly better than the other tests to confirm the clinical activity of LN [16]
We have investigated the prevalence and the value of a panel of autoantibodies as well as C3 and C4 complement fractions in predicting the activity of LN at the time of renal biopsy

Summary

Introduction

Lupus nephritis (LN) is one of the most frequent manifestations of Systemic Lupus Erythematosus (SLE) and represents a major determinant of disease morbidity and mortality [1]. Its clinical course is often characterized by flares of activity alternated with periods of quiescence, generally induced by therapy [2]. The identification of noninvasive biomarkers may help to predict the renal involvement at diagnosis and monitor relapses of LN during the follow-up. Many studies have tested the value of a number of autoantibodies for predicting or confirming the diagnosis of renal flares with contrasting results. Some [3,4,5] but not all studies [6] have demonstrated that anti-dsDNA antibodies (anti-dsDNA) and complement fractions may be useful in assessing the disease and the renal activity. One paper [7] and a recent review [8] concluded that anti-nucleosome antibodies have high prevalence in severe

Objectives

Methods

Results

Conclusion