Bhandari S, Brownjohn AM, Turney JH
Associatino of anticardiolipin antibody with the presence of
intraglomerular thrombi and renal dysfunction in lupus
nephritisi
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1770 1996
The presence of anti-cardiolipin antibodies (ACA) in some patients
with systemic lupus erythematosus (SLE) is a well established
observation. This has stimulated interest in investigating whether a
positive test for ACA can predict the presence of particular
morphologic features in renal biopsies and thus provide potentially
useful information pertaining to prognosis. Presumably this was the
impetus for this investigation although because of ambiguity in
wording of the abstract's opening two sentences it is not clear if the
"its" in "its significance" refers to the presence of intraglomerular
capillary thrombi (IGCT) or to the presence of ACA.
The study was a retrospective analysis in 50 patients with biopsy
documented lupus
nephritis, of serologic and morphologic surrogates of disease activity
and progression; namely levels of serum anti-DNA and ANA, serum C3 and
C4 levels and percentages of glomeruli with crescents, tuft necrosis
and sclerosis, all stratified according to the presence or absence of
IGCT and ACA status.
- The percentage of glomeruli with
sclerosis, crescents and tuft necrosis was found to be greater in
those specimens positive for IGCT and in ACA + patients.
- Anti-DNA
and ANA titers and hypocomplementemia correlated strongly with disease
activity in ACA+ patients as compared to the case in ACA- patients.
- Presence of IGCT correlated significantly with ACA + status.
-
ACA+ status correlated significantly with renal dysfunction at time of
biopsy whereas IGCT correlated significantly with dysfunction on
follow-up.
- Hypertension and nephrotic-level proteinuria were more
frequent in the presence of either ACA or IGCT. (6) 13 of 14 patients
suffering thrombotic complications were ACA+.
Comment: This work supports previous reports indicating
that ACA positivity is predictive of the presence of IGCT on biopsy
(Nephrol Dial Transpl 1987;2:424 and Arch Intern Med
1985;145:1389-1395). This however is at variance with the results of
2 recent studies (Lupus 1996;5:70-73 and 1994;3:25-29) which found
that ACA presence was not associated with any particular pattern of
glomerular injury, and specifically not particularly associated with
glomerular thrombosis. These last 2 studies involved 23 patients and
108 biopsies, respectively. It thus appears that the issue is still
unsettled and needs further study. (Samy S. Iskandar, MBBCh, PhD,
Bowman Gray School of Medicine, Winston-Salem, NC)
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Am Soc Nephrol
Proteinuria/Hematuria :
Lupus nephritis