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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (6): 1094-1098. doi: 10.19723/j.issn.1671-167X.2022.06.006

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Characteristics of serum autoantibodies in patients with lupus nephritis and tubulointerstitial damage

Lu ZHANG1,Cheng CHEN1,Mei-ting WENG1,Ai-ping ZHENG2,Mei-ling SU3,Qing-wen WANG1,Yue-ming CAI1,*()   

  1. 1. Department of Rheumatology & Immunology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
    2. Department of Medical Pathology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
    3. Department of Nephrology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
  • Received:2022-08-16 Online:2022-12-18 Published:2022-12-19
  • Contact: Yue-ming CAI E-mail:cyueming@163.com
  • Supported by:
    the Science and Technology Program for Basic Research in Shenzhen(JCYJ20190809095811254);Project of Shenzhen Municipal Health Commission(SZXJ2017046)

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Abstract:

Objective: To observe the tubulointerstitial damage (TID) in lupus nephritis (LN) and investigate the relationship between autoantibodies and TID in lupus nephritis. Methods: This cross-sectional study was conducted in a comprehensive tertiary hospital in Peking University Shenzhen Hospital. From March 2012 to July 2021, LN patients who performed renal biopsy were enrolled in the study. Clinical, laboratory and pathology data were collected. We classified the patients into none-or-mild group and moderate-to-severe groups according to the severity of interstitial fibrosis (IF) /tubular atrophy (TA) or tubulointerstitial inflammation (TII). The t test, U test and Chi-square test were used for statistical analysis as appropriate. Results: A total of 226 patients were included, of who 190 (84%) were female with a median age of 32 (26, 39) years. 89% (201/226) of the patients who pathologically proved to be proliferative LN by renal biopsy. The frequency of moderate-to-severe TII and moderate-to-severe IF/TA was 30% (67/226) and 34% (76/226) respectively. For autoantibodies, the patients with moderate-to-severe TII had a lower rate of positive serum anti-ribonucleoprotein (anti-RNP) antibodies than the patients with none-or-mild TII (34% vs. 51%), and moderate-to-severe IF/TA had a lower rate of positive anti-ribosomal P protein (anti-P) antibodies than patients with none-or-mild IF/TA (19% vs. 33%). For other clinical indicators, the patients with moderate-to-severe TII and moderate-to-severe IF/TA were more often combined with proliferative LN, hypertension and anemia than the patients with none-or-mild TII and none-or-mild IF/TA, respectively. The patients with moderate-to-severe TII had higher serum creatinine values and lower glomerular filtration rates than the patients with none-or-mild TII. The patients with moderate-to-severe IF/TA had higher serum creatinine values, and lower glomerular filtration rates than the patients with none-or-mild IF/TA. Conclusion: In patients with LN in Southern China, anti-RNP antibodies and anti-P antibodies may be potential protective factors for TII and IF/TA, respectively. More studies are needed to identify the risk factors of lupus patients with TID and investigate the correlation between autoantibodies and TID, which are critical for developing better preventive and therapeutic strategies to improve the survival rate of LN.

Key words: Lupus nephritis, Tubulointerstitial damage, Autoantibodies, Anti-ribonucleoprotein antibody, Anti-ribosomal P protein antibody

CLC Number: 

  • R593.24

Table 1

Baseline demographic, clinical characteristic for the study patients in the overall sample and stratified by TI or IF/TA"

Items Total (n=226) TII IF/TA
None-or-mild (n=159) Moderate-to-severe (n=67) P None-or-mild (n=150) Moderate-to-severe (n=76) P
Demographics
  Female 190 (84) 134 (84) 56 (84) 0.999 128 (85) 62 (82) 0.590
  Age/years 32 (26, 39) 31 (27, 38) 32 (26, 43) 0.510 31 (26, 37) 32 (26, 45) 0.200
Clinical characteristic
  Duration/months 14 (2, 72) 12 (2, 54) 36 (3, 96) 0.110 12 (2, 57) 24 (2, 87) 0.170
  Hypertension 72 (32) 33 (21) 39 (58) < 0.001 34 (23) 38 (50) < 0.001
Histology characteristic
  Proliferative 201 (89) 136 (86) 65 (97) 0.023 128 (85) 73 (96) 0.028
  Moderate-to-severe IF/TA 76 (34) 19 (12) 57 (85) < 0.001
  Moderate-to-severe TII 67 (30) 10 (7) 57 (75) < 0.001
Autoantibody (positive)
  Anti-dsDNA 111 (53) 78 (52) 33 (54) 0.938 76 (54) 35 (50) 0.660
  Anti-RNP 94 (46) 74 (51) 20 (34) 0.032 68 (50) 26 (37) 0.098
  Anti-Sm 54 (27) 40 (27) 14 (25) 0.815 36 (27) 18 (26) 0.999
  Anti-SSA 135 (66) 100 (69) 35 (59) 0.275 95 (70) 40 (57) 0.082
  Anti-SSB 31 (15) 20 (14) 11 (19) 0.497 18 (13) 13 (19) 0.431
  ANuA 71 (35) 49 (34) 22 (37) 0.730 46 (34) 25 (36) 0.937
  AHA 67 (33) 49 (34) 18 (31) 0.797 45 (33) 22 (31) 0.906
  Anti-P 57 (28) 45 (31) 12 (20) 0.179 44 (33) 13 (19) 0.049
  APL 27 (16) 20 (17) 7 (15) 0.887 19 (18) 8 (14) 0.680
  ANCA 22 (12) 12 (9) 10 (17.9) 0.084 11 (9) 11 (18) 0.068
Laboratory parameters
  eGFR/[mL/(min·1.73 m2)] 81.7 (51.1, 113.5) 96.2 (70.0, 123.4) 39.1 (24.1, 59.8) < 0.001 97.2 (68.9, 124.5) 43.9 (25.2, 80.5) < 0.001
  Serum creatinine/(μmol/L) 79.5 (57.5, 125.0) 67.5 (54.2, 90.0) 145.5 (102.5, 292.0) < 0.001 66.1 (54.0, 91.7) 134.5 (85.8, 218.8) < 0.001
  Lower C3 158 (72) 113 (72) 45 (73) 0.999 104 (71) 54 (75) 0.618
  Lower C4 94 (44) 71 (46) 23 (38) 0.334 65 (45) 29 (41) 0.746
  Hemoglobin/(g/L) 101.5±25.8 105.7±24.7 91.7±25.7 < 0.001 105.7±25.0 93.2±25.4 < 0.001
  Spot urine protein/creatinine/(g/g) 3.0 (1.4, 5.6) 2.8 (1.0, 5.0) 3.5 (2.0, 5.7) 0.063 2.9 (1.0, 4.7) 3.5 (2.0, 5.8) 0.081
Medications
  Treatment-naive 90 (42) 74 (49) 16 (25) 0.002 67 (47) 23 (32) 0.039
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