Potential for glomerular C4d as an indicator of thrombotic microangiopathy in lupus nephritis
Autor: | Jan A. Bruijn, Marian Roos van Groningen, Idske C L Kremer Hovinga, Ingeborg M. Bajema, Emile de Heer, Gerda M Steup-Beekman, Stefan P Berger, Marije Koopmans, Danielle Cohen |
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Rok vydání: | 2008 |
Předmět: |
Adult
Male Pathology medicine.medical_specialty Systemic disease Thrombotic microangiopathy Adolescent Biopsy Immunology Kidney Glomerulus Lupus nephritis chemistry.chemical_compound Rheumatology immune system diseases medicine Complement C4b Immunology and Allergy Humans Pharmacology (medical) Vascular Diseases Aged Retrospective Studies Creatinine medicine.diagnostic_test business.industry Complement C1q Thrombosis Complement C3 Middle Aged medicine.disease Connective tissue disease Lupus Nephritis Peptide Fragments Immunoglobulin A chemistry Immunoglobulin M Immunoglobulin G Antibodies Antiphospholipid Female Renal biopsy business Biomarkers Kidney disease |
Zdroj: | Arthritis and rheumatism. 58(8) |
ISSN: | 0004-3591 |
Popis: | Objective In patients with systemic lupus erythematosus (SLE) and lupus nephritis, the presence of antiphospholipid antibodies (aPL) is considered to be an indication of increased risk of thrombotic microangiopathy, a serious complication of SLE. Previous studies have demonstrated a critical role for activation of the classical pathway of complement that leads to thrombotic injury in the presence of aPL. This study was undertaken to investigate whether C4d deposition in lupus nephritis is related to circulating aPL and the presence of renal microthrombi. Methods Deposition patterns of C4d in 44 renal biopsy samples obtained from 38 patients with biopsy-proven lupus nephritis were determined by staining with a polyclonal anti-C4d antibody. A phosphotungstic acid–hematoxylin stain was used to identify fibrin microthrombi. Clinical data (serum creatinine levels and presence or absence of aPL) were obtained and correlated with findings in the renal biopsy specimens. Patients were categorized as having aPL (n = 20) or not having aPL (n = 18). Results A strong relationship between the intensity of glomerular C4d staining and the presence of microthrombi was found (P < 0.002). Intense glomerular C4d deposition was present in 7 of 8 biopsy samples showing renal microthrombi. Neither C4d deposition nor the presence of microthrombi was correlated with aPL status. Conclusion Our findings suggest that activation of the classical pathway of complement plays a pathogenic role in the development of renal tissue injury leading to thrombosis, irrespective of the type of circulating antibodies present. Immunodetection of glomerular C4d deposition in renal biopsy samples could be a convenient method of identifying patients at risk of thrombotic microangiopathy. |
Databáze: | OpenAIRE |
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