Frequency of Class III and IV Nephritis in Systemic Lupus Erythematosus Without Clinical Renal Involvement: An Analysis of Predictive Measures

Wakasugi, Daisuke; Gono, Takahisa; Kawaguchi, Yasushi; Hara, Masako; Koseki, Yumi; Katsumata, Yasuhiro; Hanaoka, Masanori; Yamanaka, Hisashi

doi:10.3899/jrheum.110532

Cited by 93 publications

(62 citation statements)

References 23 publications

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“…We cannot exclude that IgG1 and IgG3 are directed versus other glomerular autoantigens, and research should now focus on this point, because there are at least 11 podocyte antigens that are good candidates for being investigated. 11 We also considered that the timing of the biopsy probably has strong influence on this aspect; anticipating the biopsy at the time of presentation of minimal urinary signs would allow the identification of more precocious antibodies, because it is known [32][33][34] that renal immune deposits may anticipate the onset of clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Glomerular Autoimmune Multicomponents of Human Lupus Nephritis In Vivo (2)

Bruschi¹,

Galetti

Sinico

et al. 2015

Journal of the American Society of Nephrology

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Glomerular planted antigens (histones, DNA, and C1q) are potential targets of autoimmunity in lupus nephritis (LN). However, the characterization of these antigens in human glomeruli in vivo remains inconsistent. We eluted glomerular autoantibodies recognizing planted antigens from laser-microdissected renal biopsy samples of 20 patients with LN. Prevalent antibody isotypes were defined, levels were determined, and glomerular colocalization was investigated. Renal and circulating antibodies were matched, and serum levels were compared in 104 patients with LN, 84 patients with SLE without LN, and 50 patients with rheumatoid arthritis (RA). Autoantibodies against podocyte antigens (anti-a-enolase/antiannexin AI) were also investigated. IgG2 autoantibodies against DNA, histones (H2A, H3, and H4), and C1q were detected in 50%, 55%, and 70% of biopsy samples, respectively. Anti-DNA IgG3 was the unique non-IgG2 anti-DNA deposit, and anti-C1q IgG4 was mainly detected in subepithelial membranous deposits. Anti-H3, anti-DNA, and anti-C1q IgG2 autoantibodies were also prevalent in LN serum, which also contained IgG3 against the antigen panel and anti-C1q IgG4. Serum and glomerular levels of autoantibodies were not strictly associated. High serum levels of all autoantibodies detected, including antia-enolase and antiannexin AI, identified LN versus SLE and RA. Anti-H3 and anti-a-enolase IgG2 levels had the most remarkable increase in LN serum and represented a discriminating feature of LN in principal component analysis. The highest levels of these two autoantibodies were also associated with proteinuria.3.5 g/24 hours and creatinine.1.2 mg/dl. Our findings suggest that timely autoantibody characterization might allow outcome prediction and targeted therapies for patients with nephritis.

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Section: Discussionmentioning

confidence: 99%

Glomerular Autoimmune Multicomponents of Human Lupus Nephritis In Vivo (2)

Bruschi¹,

Galetti

Sinico

et al. 2015

Journal of the American Society of Nephrology

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“…Egy vizsgá-latban SLE-s betegeknek ajánlották fel a biopsziás mintavétel lehetőségét, 55%-uknak nem volt klinikailag vesebetegségre utaló tünete, ennek ellenére a klinikailag tünetmentes betegek 15%-ánál III-as vagy IV-es, további 10%-uknál V-ös stádiumú lupus nephritist diagnosztizál-tak [13].…”

Section: A Lupus Nephritis Osztályozása Lefolyása Prognózisaunclassified

A lupus nephritis kezelésének irányelvei, valamint a mycofenolat mofetil hatékonyságának bemutatása intézetünk lupus nephritises betegeinek körében

Szabó

Kiss

2016

Orvosi Hetilap

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A lupus nephritis kezelésének irányelvei, valamint a mycofenolat mofetil hatékonyságának bemutatása intézetünk lupus nephritises betegeinek körébenSzabó Melinda Zsuzsanna dr. ■ Kiss Emese dr. Országos Reumatológiai és Fizioterápiás Intézet, BudapestA szerzők közleményükben a lupus nephritis kezelésének legújabb irányelvei mellett bemutatják saját mycofenolat mofetillel szerzett tapasztalataikat a betegség kezelésében. A lupus nephritis és főleg a proliferatív formája olyan gyakori és komoly manifesztációja a szisztémás lupus erythematosusnak, amely végstádiumú veseelégtelenséghez vagy akár halálhoz is vezethet. Az elmúlt évtizedekben a lupus nephritis kezelése sokat fejlődött, ma már a kedvezőbb mellékhatás-profilú mycofenolat mofetil a cyclophosphamid alternatívájává vált a III-as és IV-es osztályú glomerulonephritis indukciós és fenntartó kezelésében. Lupus nephritis diagnózissal eddig 25 betegüknek kértek egyedi méltányosság alapján támogatást mycofenolat mofetil adására. Szövettanilag legtöbben a WHO III (A/C) és IV (A) szövettani osztályába tartoztak (30-30%), beszűkült vesefunkció csak 16%-ukban volt jelen. Glükokortikoid és cyclophosphamid indukciós kezelés után adott mycofenolatterápia mellett az átlagos napi proteinuria 3,18 g/napról 1,06 g/napra csökkent. A betegek 24%-ánál jött létre komplett, 48%-ánál részleges remisszió. Ezek alapján a mycofenolat mofetil hatékony kezelésnek tartható a proliferatív lupus nephritis kezelésében. Orv. Hetil., 2016, 157(35), 1385-1393.Kulcsszavak: lupus nephritis, szisztémás lupus erythematosus, mycofenolat mofetil, cyclophosphamid, rituximab Clinical guideline for the treatment of lupus nephritis and single-centre results of mycofenolate mofetil among patients with lupus nephritis in the National Institute of Rheumatology and Physiotherapy, BudapestThe authors present the latest guideline for the treatment of lupus nephritis and their own single-centre results with mycofenolate mofetil treated lupus nephritis. Lupus nephritis and mainly its proliferative form is a frequent and potentially life-threatening manifestation of systemic lupus erythematosus that can lead to end-stage renal disease. The treatment of lupus nephritis greatly improved in the last decades; mycofenolate mofetil has become an alternative of cyclophosphamide both in remission induction and as a maintenance regimen as well in the treatment of Class III and IV glomerulonephritis. The authors ordered mycofenolate mofetil for 25 patients with lupus nephritis so far. Histologically most of them had Class III (A/C) or IV (A) glomerulonephritis (30-30%), and only 16% of the patients had renal impairment at that time. Mycofenolate mofetil given after glucocorticoid and cyclophosphamide induction therapy reduced the daily proteinuria from 3.18 grs to 1.06 grs. Complete remission could be achieved in 24% and partial remission in 48% of the patients. The authors conclude that mycofenolate mofetil is effective in the therapy of lupus nephritis.

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“…More recently, LN other than class I was found in 58% of biopsied patients without clinical renal involvement. Of note, class III or IV LN was found in 15% of these patients (71).…”

Section: Clinicopathologic Correlationsmentioning

confidence: 99%

Lupus Nephritis

Giannico

Fogo

2013

Clinical Journal of the American Society of Nephrology

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SummaryMost patients with SLE develop kidney disease related to this systemic underlying disease process. Lupus nephritis is an important cause of morbidity and even mortality in patients with systemic lupus erythematosus. Lupus nephritis has diverse morphologic manifestations with varying clinical presentations and consequences. The pathogeneses involve immune complexes, which can deposit anywhere in the kidney, and other mechanisms, including endothelial injury, podocytopathy, and tubulointerstitial injury. Treatment and prognosis accordingly range from excellent even with only observation with minimal mesangial deposits, to kidney failure despite aggressive immunosuppression in patients with severe proliferative disease. Renal biopsy plays a crucial role in the diagnosis of the specific form of lupus nephritis in any patient. However, the role of the renal biopsy in prediction of outcome, treatment, and prognosis has been controversial. We will review the current classification of lupus nephritis and the value of renal biopsy in the management of these patients.

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Frequency of Class III and IV Nephritis in Systemic Lupus Erythematosus Without Clinical Renal Involvement: An Analysis of Predictive Measures

Cited by 93 publications

References 23 publications

Glomerular Autoimmune Multicomponents of Human Lupus Nephritis In Vivo (2)

Glomerular Autoimmune Multicomponents of Human Lupus Nephritis In Vivo (2)

A lupus nephritis kezelésének irányelvei, valamint a mycofenolat mofetil hatékonyságának bemutatása intézetünk lupus nephritises betegeinek körében

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