Anti-dsDNA, anti-Sm antibodies, and the lupus anticoagulant: significant factors associated with lupus nephritis

Abstract

Background: Lupus nephritis (LN) is a common manifestation in patients with systemic lupus erythematosus (SLE). Autoantibodies and ethnicity have been associated with LN, but the results are controversial. Objective: To study the immunological and demographic factors associated with the development of LN. Patients and methods: A retrospective case-control study of 127 patients with biopsy-proven LN, and 206 randomly selected patients with SLE without nephritis as controls was designed. All patients had attended our lupus unit during the past 12 years. Standard methods were used for laboratory testing. Results: Patients with LN were significantly younger than the controls at the time of SLE diagnosis (mean (SD) 25.6 (8.8) years v 33.7 (12.5) years; p<0.0001). The proportion of patients of black ethnic origin was significantly higher in the group with nephritis (p=0.02). There were no differences in sex distribution or duration of follow up. A higher proportion of anti-dsDNA, anti-RNP, anti-Sm, and lupus anticoagulant (LA) was seen in the group with nephritis (p=0.002; p=0.005; p=0.0001; p=0.01, respectively). In univariate, but not in multivariate, analysis male sex and absence of anti-dsDNA were associated with earlier onset of renal disease (p=0.03; p=0.008). In multivariate analysis the only factors associated with nephritis were younger age at diagnosis of SLE, black race, presence of anti-dsDNA, anti-Sm, and LA. No demographic or immunological associations were seen with WHO histological classes. Conclusions: Young, black patients with anti-dsDNA, anti-Sm antibodies, and positive LA, appear to have a higher risk of renal involvement. These patients should be carefully monitored for the development of LN.

Systemic lupus erythematosus in a multiethnic cohort: LUMINA XXXV. Predictive factors of high disease activity over time

“…These antibodies have been generally associated with disease activity 41 42 and with lupus nephritis, [42][43][44] but not concomitantly with flares, because as immune complexes are deposited in tissues their circulating levels decrease. 45 46 Thus, it is not surprising that we found these antibodies to be associated with high disease activity, particularly considering that they were obtained at T0 and not at the preceding visit.…”

Elevated Subclinical Double-Stranded DNA Antibodies and Future Proliferative Lupus Nephritis

“…Recent animal data support the theory that LN is triggered by the direct binding of anti-dsDNA antibody to the glomerular basement membrane (GBM), although previous studies purport that the antibody needs to complex with nucleosomes in circulation or with chromatin in situ (10). There is a strong association between anti-dsDNA antibodies and LN, and, more specifically, proliferative LN (PLN), at the time of diagnosis (3,(11)(12)(13)(14). Absolute quantitative level and rate of increase in anti-dsDNA antibodies in LN have not been previously evaluated.…”

“…Before any prospective validation, our model would benefit from further investigation to address current (3,34). This is essential because antidsDNA antibody cannot independently account for the pathogenesis of PLN.…”

“…More than half of patients with SLE develop lupus nephritis (LN), often after the original diagnosis of SLE (3). LN can present with a wide range of clinical and histopathologic findings.…”

A Study of Correlation between Proteinuria and Histological Findings in Lupus Nephritis Patient

“…[1,2] Renal involvement in SLE occurs in 40-75 percent of patients most frequently in a period of 5 years after the onset of the disease. It is one of the strongest predictors of poor outcome.…”