NDT Advance Access originally published online on July 28, 2006
Nephrology Dialysis Transplantation 2006 21(11):3115-3121; doi:10.1093/ndt/gfl436
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High prevalence of anti-C1q antibodies in biopsy-proven active lupus nephritis
1Internal Medicine B and Clinical Immunology lab, University Hospital Basel, Basel, Switzerland, 2Department of Immunology, University Hospital La Paz, Madrid, Spain, 33rd Clinic of Medicine, General Faculty Hospital, 1st Faculty of Medicine, Charles University, Prague, Czech Republic, 4Institutes of Pathology, University Hospitals of Geneva and Lausanne and 5Rheumatology lab, Felix Platter Hospital, Basel, Switzerland, 6Service d’immunologie biologique, Hopital Europeen Georges Pompidou, Paris, France, 7Department of Nephrology, University Hospital La Paz, Madrid, Spain, 8Clinic of Nephrology, General Faculty Hospital, 1st Faculty of Medicine, Charles University, Prague, Czech Republic, 9Department of Pathology, University Hospital La Paz, Madrid, Spain, 10Department of Pathology, Charles University, Prague, Czech Republic, 11Immunonephrology lab and 12Internal Medicine B and Immunonephrology lab, University Hospital Basel, Basel, Switzerland
Correspondence and offprints requests to: Marten Trendelenburg, MD, Laboratory for Clinical Immunology, Department of Research, University Hospital Basel, Hebelstr. 20, CH–4031 Basel, Switzerland. Email: marten.trendelenburg{at}unibas.ch
Background. Anti-C1q antibodies (anti-C1q) have been shown to correlate positively with systemic lupus erythematosus (SLE) nephritis. Several clinical studies indicated a high negative predictive value, suggesting that active lupus nephritis is rarely seen in patients with no anti-C1q. However, the true prevalence of anti-C1q at the time of active lupus nephritis has not been well established. The aim of this study was to determine prospectively the prevalence of anti-C1q in proven active lupus nephritis at the time of the renal biopsy.
Methods. In this prospective multi-centre study, we investigated adult SLE patients undergoing renal biopsy for suspected active lupus nephritis. Serum samples were taken at the time of the biopsy and analysed for the presence of anti-C1q in a standardized way. The activity of lupus nephritis was classified according to the renal histology. Biopsies were also analysed for the presence of glomerular IgG, C1q and C3 deposition.
Results. A total of 38 patients fulfilling at least 4/11 American College of Rheumatology (ACR) criteria for the diagnosis of SLE were included. Out of this, 36 patients had proliferative (class II, III or IV) and two had class V lupus nephritis. All but one patient with proliferative lupus nephritis were positive for anti-C1q (97.2%) compared with the 35% of control SLE patients with inactive lupus nephritis and 25% of SLE patients without lupus nephritis ever. All patients were positive for glomerular C1q (36/36) and 37/38 patients had glomerular IgG deposits. Anti-C1q strongly decreased during successful treatment.
Conclusions. Anti-C1q have a very high prevalence in biopsy-proven active lupus nephritis, thus a negative test result almost excludes active nephritis. The data support the hypothesis of a pathogenic role of anti-C1q in lupus nephritis.
Keywords: autoantibodies; complement; SLE
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