Rheumatology International

, Volume 11, Issue 2, pp 77–82 | Cite as

Relation between serological data at the time of biopsy and renal histology in lupus nephritis

  • I. C. Nossent
  • S. C. Henzen-Logmans
  • T. M. Vroom
  • V. Huysen
  • J. H. M. Berden
  • A. J. G. Swaak


As autoantibodies are thought to participate in the pathogenesis of renal inflammation in systemic lupus erythematosis (SLE) we investigated associations between serological markers of disease activity in SLE and the activity of renal histopathological lesions in thirty-five patients with lupus nephritis (LN). We found the following prevalence of serum auto-antibodies in LN: IgG antinuclear antibodies (ANA) 100%, IgM ANA 69%, IgA ANA 60%, IgG anti-dsDNA 60%, IgM antidsDNA 71%, IgA anti-dsDNA 60%, anti-RNP 20%, anti-Sm 14%, anti-SSA 31%, anti-SSB 14%, anti-histone 37%, anti-cardiolipin 80% and antibody to ribosomal protein (anti-P) 6%. No correlation was found between serological parameters and the WHO-classification of biopsies. The activity-index of histological lesion, assessed according to the NIH-renal histology scoring system, correlated with IgM ANA and IgM anti-dsDNA titers. Of all the specific features of histological renal inflammation, glomerular proliferation showed the best overall correlation with serological parameters of disease activity. Anticardiolipin antibodies were correlated with overall disease activity, but not with renal histological activity. Thus, serological markers of disease activity did not adequately reflect the amount of renal inflammation in LN and cannot replace renal biopsy as a diagnostic tool.

Key words

Lupus nephritis Serology Histology 


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  1. 1.
    Muehrcke RC, Kark RM, Pirani CL, Pollak VE (1957) Lupus nephritis: a clinical and pathologic study based on renal biopsies. Medicine 35:1–14Google Scholar
  2. 2.
    Baldwin D, Gluck M, Lowenstein J, Gallo G (1977) Lupus nephritis: clinical course as related to morphologic forms and their transitions. Am J Med 62:12–16Google Scholar
  3. 3.
    Wallace D, Podell T, Weiner J, Cox J, Klinenberg J, Forouzesh S, Dubois E (1982) Lupus nephritis, experience with 230 patients in a private practice. Am J Med 72:209–219Google Scholar
  4. 4.
    Austin H, Muenz L, Joyce K, Antonovych T, Kullik M, Klippel J, Decker J (1983) Prognostic factors in lupus nephritis: contribution of renal histological data. Am J Med 75:382–391Google Scholar
  5. 5.
    Austin H, Muenz L, Joyce K et al. (1985) Diffuse proliferative lupus nephritis: identification of specific pathologic features affecting renal outcome. Kidney Int 25:689–695Google Scholar
  6. 6.
    Dujour I, Pollack VE, Pirani CL, Dillard MG (1972) The distribution and character of glomerular deposits in systemic lupus erythematosus. Kidney Int 2:33–38Google Scholar
  7. 7.
    Okada M (1980) Methylprednisolone pulse therapy: a histopathological evaluation. Kidney Dialysis 8:535–541Google Scholar
  8. 8.
    Nossent JC, Henzen-Logmans SC, Vroom TM, Berden JHM, Swaak AJG (1990) Contribution of renal biopsy data in predicting outcome in lupus nephritis. Analysis of 116 patients. Arthritis Rheum 33:970–977Google Scholar
  9. 9.
    Agnello V, Koffler D, Kunkel HG (1973) Immune complex systems in the nephritis of systemic lupus erythematosus. Kidney Int 3:90–97Google Scholar
  10. 10.
    Fournie GJ (1988) Circulating DNA and lupus nephritis. Kidney Int 33:487–497Google Scholar
  11. 11.
    Hunsicker CLG, Ruddy S, Carpenter CB, Schur PH, Merrill JD, Muller-Eberhardt HJ, Austen KF (1972) Metabolism of third complement component (C3) in nephritis. N Engl J Med 287:835–840Google Scholar
  12. 12.
    Tan EM, Cohen AS, Fries JF, Mesi AT, McShaire DJ, Rothfield N, Schaller JG, Talal N, Winchester R (1982) The 1982 revised criteria for the classification of SLE. Arthritis Rheum 25:1271–1277Google Scholar
  13. 13.
    Chang C, Urowitz MB, Gladman D, Bombardier C (1986) Impact of Systemic Lupus Erythematosus disease activity on survival with validation of a disease activity index in Systemic Lupus Erythematosus. Arthritis Rheum 29:593Google Scholar
  14. 14.
    Liang MH, Socher SA, Larson MG, Schur PH (1989) Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus. Arthritis Rheum 32:1107–1118Google Scholar
  15. 15.
    McCluskey RT (1976) Lupus nephritis. In: Sommers SC (ed) Kidney pathology decennial 1966–1975. Appleton-Century-Crofts, New York, pp 435–460Google Scholar
  16. 16.
    Balow JE (1979) Clinicopathological correlations in lupus nephritis. In: Systemic lupus erythematosus: evolving concepts, moderated by Decker JL. Ann Intern Med 91:587–604Google Scholar
  17. 17.
    Pirani CL, Salinas L (1968) Evaluation of percutaneous renal biopsies. Pathol Annu 3:249–296Google Scholar
  18. 18.
    Malden DP, Nakamura RM, Tan EM (1984) Standardization of the immuno-fluorescence test fon auto-antibody to nuclear antigens (ANA). Am J Clin Pathol 82:57–66Google Scholar
  19. 19.
    Aarden L, Smeenk R (1981) Measurements of antibodies specific for DNA. In: Lefkovitz I, Pernis B (eds) Immunological methods, vol I. Academic Press, New York, pp 75–82Google Scholar
  20. 20.
    Smeenk RJT, Aarden LA (1980) The use of PEG precipitation to detect low avidity antibodies to dsDNA. J Immunol Methods 39:165–180Google Scholar
  21. 21.
    Kurata N, Tan EM (1976) Identification of antibodies to nuclear acidic antigens by counter immunoelectrophoresis. Arthritis Rheum 19:574–580Google Scholar
  22. 22.
    Smeenk RJT, Lucassen WH, Swaak AJG (1987) Is anticardiolipin activity a cross reaction of anti-DNA or a separate entity. Arthritis Rheum 30:607–617Google Scholar
  23. 23.
    Rubin RL, McNally EM, Nusingow SR, Robinson CA, Tan EM (1985) IgG antibodies to the histone complex H2A-H2B characterize procainamide induced lupus. Clin Immunol Immunopathol 36:49–59Google Scholar
  24. 24.
    Bonfa E, Golombek SJ, Kaufman LD et al. (1987) Association between lupus psychosis and anti-ribosomal P protein antibodies. N Engl J Med 317:265–271Google Scholar
  25. 25.
    Senaldi G, Makinde VA, Vergani D, Isenberg DA (1988) Correlation of the activation of the fourth component of complement (C4) with disease activity in systemic lupus erythematosus. Ann Rheum Dis 47:913–917Google Scholar
  26. 26.
    Hill GS, Hinglais N, Tron F, Bach JF (1978) Systemic lupus erythematosus. Morphologic correlation with immunologic and clinical data at the time of biopsy. Am J Med 64:61–79Google Scholar
  27. 27.
    Magil AB, Ballon HS, Chan VD, Lirenman DS, Rae A, Sutton RAL (1984) Diffuse proliferative lupus glomerulonephritis. Determination of prognostic significance of clinical, laboratory and pathologic factors. Medicine 63:210–220Google Scholar
  28. 28.
    Weinstein A, Bardwell B, Stone B, Tibbets C, Rothfield NF (1983) Antibodies to native DNA and serum complement (C3) levels. Am J Med 74:206–216Google Scholar
  29. 29.
    Cameron JS, Turner DR, Ogg CS et al. (1979) Systemic lupus with nephritis: a long-term study. Q J Med 189:1–24Google Scholar
  30. 30.
    Nossent JC, Huysen V, Smeenk RJT, Swaak AJG (1989) Low avidity antibodies to double stranded DNA in systemic lupus erythematosus: a longitudinal study of their clinical significance. Ann Rheum Dis 48:677–682Google Scholar
  31. 31.
    Nossent JC, Huysen V, Smeenk RJT, Swaak AJG (1989) Low avidity antibodies to dsDNA as a diagnostic tool. Ann Rheum Dis 48:748–752Google Scholar
  32. 32.
    Swaak AJG, van Rooyen A, Vogelaar C, Pillay M, Hack CE (1986) Complement (C3) metabolism in systemic lupus erythematosus in relation to the disease course. Rheumatol Int 6:221–226Google Scholar
  33. 33.
    Pollack VE, Pirani CL (1987) The kidney in systemic lupus erythematosus. In: Wallace DJ, Dubois EL (eds) Dubois' lupus erythematosus. Lea and Febiger, Philadelphia, pp 105–129Google Scholar
  34. 34.
    Morel-Maroger L, Mery JP, Droz D (1976) The course of lupus nephritis: contribution of serial renal biopsies. In: Hamburger J, Crosnier J (eds) Advances in nephrology. Year Book Med Publ, Chicago, pp 79–118Google Scholar
  35. 35.
    Sontheimer RD, Gillian JN (1978) DNA antibody class, subclass and complement fixation in systemic lupus erythematosus with and without nephritis. Clin Immunol Immunopathol 10:459–467Google Scholar
  36. 36.
    Feldman MC, Huston DP, Karsh J, Balow J, Klima E, Steinberg AD (1982) Correlation of serum IgG, IgM and anti-native DNA antibodies with renal and clinical indices of activity in SLE. J Rheumatol 9:52–58Google Scholar
  37. 37.
    Goodman JW, Wang AC (1980) Immunoglobulins: structure, diversity and genetics. In: Fundberg HH, Stittes DP, Caldwell JL, Wells JV (eds) Basic and clinical immunology. Lange Medical Publications, California, pp 28–43Google Scholar
  38. 38.
    Kanayaura Y, Peebles C, Tan EM, Curd JG (1986) Complement activating abilities of defined antinuclear antibodies. Arthritis Rheum 29:748–754Google Scholar
  39. 39.
    Koffler D, Agnello A, Kunkel HG (1974) Polynucleotide immune complexes in serum and glomeruli of patients with systemic lupus erythematosus. Am J Pathol 74:109–122Google Scholar
  40. 40.
    Maddison PJ, Reichlin M (1979) Deposition of antibodies to a soluble cytoplasmic antigen in the kidneys of patients with systemic lupus erythematosus. Arthritis Rheum 22:858–863Google Scholar
  41. 41.
    Kohda S, Kanayama Y, Okansura M et al. (1989) Clinical significance of antibodies to histones in systemic lupus erythematosus. J Rheumatol 16:24–28Google Scholar
  42. 42.
    Colaco CB, Elkon KB (1985) The lupus anticoagulant. A disease marker in antinuclear antibody negative lupus that is cross-reactive with auto-antibodies to dsDNA. Arthritis Rheum 28:67–74Google Scholar
  43. 43.
    Santiago MB, Cossermelli W, Tuma MF, Pinto MN, Oliveira RM (1989) Anticardiolipin antibodies in patients with infectious diseaes. Clin Rheumatol 8:23–28Google Scholar
  44. 44.
    Shergy WL, Kredich DW, Pisetsky DS (1988) The relationship of anticardiolipin antibodies to disease manifestations in pediatric systemic lupus erythematosus. J Rheumatol 15:1389–1394Google Scholar
  45. 45.
    Harris EN, Chan JKH, Asherson RA, Aber VE, Gharavi E, Hughes GRV (1986) Thrombosis, recurrent fetal loss and thrombocytopenia. Predictive value of an anticardiolipin antibody test. Arch Intern Med 146:2153–2156Google Scholar
  46. 46.
    Shashi Kant K, Pollack VE, Dosekun A, Glas-Greenwaldt P, Weis MA, Glueck HI (1985) Lupus nephritis with thrombosis and abnormal fibrinolysis: effect of ancrod. J Lab Clin Med 105:77–83Google Scholar
  47. 47.
    Hardin JA, Cronlund M, Haber E, Bloch KJ (1978) Activation of blood clotting in patients with systemic lupus erythematosus. Am J Med 65:430–436Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • I. C. Nossent
    • 1
    • 2
    • 3
    • 4
  • S. C. Henzen-Logmans
    • 1
    • 2
    • 3
    • 4
  • T. M. Vroom
    • 1
    • 2
    • 3
    • 4
  • V. Huysen
    • 1
    • 2
    • 3
    • 4
  • J. H. M. Berden
    • 1
    • 2
    • 3
    • 4
  • A. J. G. Swaak
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of RheumatologyDr Daniel den Hoed ClinicRotterdamThe Netherlands
  2. 2.Department of PathologyDr Daniel den Hoed ClinicRotterdamThe Netherlands
  3. 3.Department of Autoimmune DiseasesCentral Laboratory of the Netherlands Red Cross Blood Transfusion ServiceAmsterdamThe Netherlands
  4. 4.Department of Nephrology, St. Radboud HospitalUniversity of NijmegenNijmegenThe Netherlands

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