Coremans IEM, Spronk PE, Bootsma H, Daha MR, van der Voort
EAM, Kater L, Breedveld FC, Kallenberg CG
Changes in antibodies to C1q predict renal relapses in systemic
lupus erythematosus
Am J Kidney Dis
(Oct) 26:595-601 1995
The authors in this manuscript use the cohort of 151 patients with SLE who
were followed in their programs between 1988-1993 at three month intervals
and selected the first 17 patients who developed renal relapse, the first
16 patients who developed a relapse in nonrenal organs and 10 randomly
selected patients without relapse and measured levels of anti-C1q and
anti-dsDNA prospectively. The three groups of patients were well matched
with regard to clinical features. Anti-C1q was detected in 12 of 17
patients, primarily with renal relapse compared with 6 of 16 patients with
nonrenal flares and 2 of 10 patients who remained clinically inactive.
These values were statistically significant. Anti-dsDNA was detected in 13
of 17 patients with primarily renal relapse compared with 15 of 16 patients
with nonrenal flares and 5 of 10 patients who were clinically inactive,
again statistically significant. Anti-dsDNA and Anti-C1q correlated
closely. In patients with renal relapse, both antibodies increased
beginning four months prior to relapse and reached a peak at the moment of
relapse. In patients with nonrenal relapse, anti-dsDNA remained high for
the entire observation period. No changes in these antibodies were seen in
inactive patients. The mean time between occurrence of the significant
increase in the antibody titer and the moment of relapse was 2.3 months for
both antibodies.
With respect to predicting power for these antibodies for the development
of relapse, there was no difference in predictive power for renal relapse
between anti-C1q and anti-dsDNA. Anti-dsDNA had the highest sensitivity
for predicting all kinds of disease exacerbations whereas anti-C1q had the
highest specificity for predicting renal relapse. The authors speculate on
the potential role the increased levels of anti-C1q found in all patients
with a proliferative form of lupus nephritis may play. They suggest that
this antibody can be deposited in the glomerular basement membrane as a
trapped circulating immune complex and some of their experimental work
support this concept. They conclude that serial measurement of plasma C1q
and anti-dsDNA are helpful because an increase in the anti-C1q level is
associated with renal relapse whereas an increase in the anti-dsDNA is
associated with all forms of relapse in patients with SLE.
(Krane)
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Proteinuria/Hematuria :
Lupus nephritis