Markers of childhood lupus nephritis indicating disease activity

Pediatr Nephrol. 2011 Mar;26(3):401-10. doi: 10.1007/s00467-010-1720-x. Epub 2010 Dec 22.

Abstract

Current treatment regimens for childhood lupus nephritis (LN) are associated with significant side-effects and toxicity in vulnerable phases of growth and development. The paucity of biomarkers particularly in childhood impedes the appropriate clinical management and the development of new therapeutics. We analyzed markers of immune system (BAFF, RANTES), complement (Bb, C1q, C3d-CIC, C5a) and endothelial cell activation (sVCAM-1) in children with LN (n=22, mean age 14.8±4.7 years), nephrotic syndrome (n=13) and age-matched healthy controls (n=20) to define parameters that correlate with LN activity. Complement fragments of the alternative (Bb, p=0.0004) classical (C3d-CIC, p<0.0001) and common pathway (C5a, p<0.0001) and the levels of BAFF (p<0.0001), RANTES (p=0.0002) and sVCAM-1 (p=0.0004) were significantly higher in active compared to inactive LN. Activation of complement was associated with the occurrence of anti-C1q antibodies and reduced complement C1q. Complement-activation fragments highly correlated with the markers for immune system and endothelial cell activation. The ensemble of these parameters may be of great value in identifying early flares or remissions of childhood LN, and moreover may prove useful in the assessment of new treatments and in determining the optimization of their use.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Austria
  • B-Cell Activating Factor / blood
  • Biomarkers / blood
  • Case-Control Studies
  • Chemokine CCL5 / blood
  • Child
  • Complement Activation*
  • Complement System Proteins / metabolism
  • Endothelial Cells / immunology*
  • Female
  • Germany
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Linear Models
  • Lupus Nephritis / diagnosis
  • Lupus Nephritis / drug therapy
  • Lupus Nephritis / immunology*
  • Male
  • Monitoring, Immunologic / methods*
  • Predictive Value of Tests
  • Treatment Outcome
  • Vascular Cell Adhesion Molecule-1 / blood
  • Young Adult

Substances

  • B-Cell Activating Factor
  • Biomarkers
  • CCL5 protein, human
  • Chemokine CCL5
  • Immunosuppressive Agents
  • TNFSF13B protein, human
  • Vascular Cell Adhesion Molecule-1
  • Complement System Proteins