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Year : 2007  |  Volume : 17  |  Issue : 2  |  Page : 53-60

Study of renal histopathological correlation with anticardiolipin antibody status in patients with systemic lupus erythematosus

Department of Medicine, KEM Hospital and Seth GS Medical College, Parel, Mumbai, India

Correspondence Address:
Ramshekhar N Menon
Department of Medicine, KEM Hospital and Seth GS Medical College, Parel, Mumbai - 400 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-4065.37021

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Background: Detection of antiphospholipid antibodies in patients with lupus nephritis is useful not only to identify patients at a risk for vascular and obstetric manifestations but also for their potential deleterious impact on renal outcome. Materials and Methods: 50 patients who met the American Rheumatology Association criteria for systemic lupus erythematosus (SLE) and (under suspicion of lupus nephritis) qualified for renal biopsy were enrolled into this observational study. In addition to the standard protocol of investigations in SLE, anticardiolipin antibody (aCL) status was determined during the initial workup and was confirmed after 6 weeks. Renal biopsy was studied by a senior experienced pathologist. In addition to the WHO class discrete histological markers of morbidity such as capillary thickening, hyaline thrombi, crescent and wire-loop formation, interstitial fibrosis and tubular atrophy were studied. Hypocomplementemia, urine analysis and renal function tests were also compared between aCL+ and aCL- patients. Results: 58% of the patients were aCL+ according to a standard ELISA estimation. Antiphospholipid Syndrome Nephropathy (APSN) was detected in 4 out of 28 aCL+ patients ( P = 0.4). There was no difference in the SLE Disease Activity Index (SLEDAI) scores between the two groups. There was evidence of persistent hypocomplementemia (C3 or C3 and C4) at the end of 6 months on therapy in aCL+ patients. ( P = 0.008). This significance was not attained in terms of azotemia, active urinary sediments or proteinuria. There was no difference in WHO (or RPS) class prevalence and calculated activity and chronicity scores. However, there was a greater incidence of capillary thickening ( P = 0.08), interstitial fibrosis ( P = 0.019) and tubular atrophy ( P = 0.052) in aCL+ patients as opposed to the quantitative score assessment using the activity and chronicity indices. Conclusions: Hypocomplementemia is the only probable marker of renal morbidity in the laboratory follow-up of the SLE patients. aCL positivity does contribute to greater incidence of interstitial fibrosis, tubular atrophy and capillary wall thickening in biopsy specimens. APSN is an independent entity that must be specifically sought for on histological assessment.


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Indian Journal of Nephrology
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Online since 20th Sept '07