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Urinary CD8+ T-cell counts discriminate between active and inactive lupus nephritis.

Dolff S, Abdulahad WH, Arends S, van Dijk MC, Limburg PC, Kallenberg CG, Bijl M - Arthritis Res. Ther. (2013)

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ABSTRACT

Introduction: Lupus nephritis (LN) is a severe and frequent manifestation of systemic lupus erythematosus (SLE). Early detection of initial renal manifestations and relapses during follow-up is pivotal to prevent loss of renal function. Apart from renal biopsies, current urinary and serological diagnostic tests fail to accurately demonstrate the presence of active LN. Previously, we demonstrated that effector memory T-cells (CD45RO+CCR7-;TEM) migrate into the urine during active LN. The objective of this study was to assess the diagnostic value of urinary T-cells in comparison with traditional markers of active LN.

Methods: T-cells in the urine during active LN and remission were investigated. Twenty-two, in most cases biopsy-proven, active LN patients and 24 SLE patients without active LN were enrolled and serial measurements were performed in 16 patients.

Results: Analysis of the urinary sediment in active renal disease showed an increased number of CD8+ T-cells and absence of these cells during remission. Enumerating T-cell counts in LN patients with a history of renal involvement was a superior marker of active LN in comparison to traditional markers, such as proteinuria and s-creatinine.

Conclusions: In conclusion, urinary T-cells, in particular CD8+ T cells, are a promising marker to assess renal activity in LN patients, in particular in those with prior renal involvement.

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Laboratory data of serially analyzed LN patients (n = 16) during active and inactive LN. Intra-individual comparison between levels of C3, C4, anti-dsDNA titres, proteinuria, s-creatinine, urinary CD4+ and CD8+ T-cell counts in lupus nephritis (LN) patients (n = 16) during active and inactive LN is shown in sections A-G. The time interval between these two assessments was 14 ± 4 months. P-values were calculated using the nonparametric Wilcoxon signed rank test. Significant differences are indicated (P <0.05 = *, P <0.005 = **).
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Figure 1: Laboratory data of serially analyzed LN patients (n = 16) during active and inactive LN. Intra-individual comparison between levels of C3, C4, anti-dsDNA titres, proteinuria, s-creatinine, urinary CD4+ and CD8+ T-cell counts in lupus nephritis (LN) patients (n = 16) during active and inactive LN is shown in sections A-G. The time interval between these two assessments was 14 ± 4 months. P-values were calculated using the nonparametric Wilcoxon signed rank test. Significant differences are indicated (P <0.05 = *, P <0.005 = **).

Mentions: Urine specimens of 16 patients were analyzed at the time of active renal disease and remission (Δ t = 14 ± 4 months) to assess intra-individual changes in urinary T-cell counts. Fifteen of these patients were active at baseline and treated with induction therapy for LN. One patient was in renal remission at baseline and had a biopsy proven relapse during follow-up. Urinary CD4+ T-cell counts decreased significantly from 125 (0 to 569 cells/ml) to 0 (0 to 82 cells/ml, P = 0.001, Figure 1) from active renal disease into remission. CD8+ T-cells decreased from 124 (0 to 841 cells/ml) to 0 (0 to 33 cells/ml, P <0.0001). SLEDAI scores decreased significantly from 13 ± 3 to 3 ± 2 (P <0.0001).


Urinary CD8+ T-cell counts discriminate between active and inactive lupus nephritis.

Dolff S, Abdulahad WH, Arends S, van Dijk MC, Limburg PC, Kallenberg CG, Bijl M - Arthritis Res. Ther. (2013)

Laboratory data of serially analyzed LN patients (n = 16) during active and inactive LN. Intra-individual comparison between levels of C3, C4, anti-dsDNA titres, proteinuria, s-creatinine, urinary CD4+ and CD8+ T-cell counts in lupus nephritis (LN) patients (n = 16) during active and inactive LN is shown in sections A-G. The time interval between these two assessments was 14 ± 4 months. P-values were calculated using the nonparametric Wilcoxon signed rank test. Significant differences are indicated (P <0.05 = *, P <0.005 = **).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672789&req=5

Figure 1: Laboratory data of serially analyzed LN patients (n = 16) during active and inactive LN. Intra-individual comparison between levels of C3, C4, anti-dsDNA titres, proteinuria, s-creatinine, urinary CD4+ and CD8+ T-cell counts in lupus nephritis (LN) patients (n = 16) during active and inactive LN is shown in sections A-G. The time interval between these two assessments was 14 ± 4 months. P-values were calculated using the nonparametric Wilcoxon signed rank test. Significant differences are indicated (P <0.05 = *, P <0.005 = **).
Mentions: Urine specimens of 16 patients were analyzed at the time of active renal disease and remission (Δ t = 14 ± 4 months) to assess intra-individual changes in urinary T-cell counts. Fifteen of these patients were active at baseline and treated with induction therapy for LN. One patient was in renal remission at baseline and had a biopsy proven relapse during follow-up. Urinary CD4+ T-cell counts decreased significantly from 125 (0 to 569 cells/ml) to 0 (0 to 82 cells/ml, P = 0.001, Figure 1) from active renal disease into remission. CD8+ T-cells decreased from 124 (0 to 841 cells/ml) to 0 (0 to 33 cells/ml, P <0.0001). SLEDAI scores decreased significantly from 13 ± 3 to 3 ± 2 (P <0.0001).

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Lupus nephritis (LN) is a severe and frequent manifestation of systemic lupus erythematosus (SLE). Early detection of initial renal manifestations and relapses during follow-up is pivotal to prevent loss of renal function. Apart from renal biopsies, current urinary and serological diagnostic tests fail to accurately demonstrate the presence of active LN. Previously, we demonstrated that effector memory T-cells (CD45RO+CCR7-;TEM) migrate into the urine during active LN. The objective of this study was to assess the diagnostic value of urinary T-cells in comparison with traditional markers of active LN.

Methods: T-cells in the urine during active LN and remission were investigated. Twenty-two, in most cases biopsy-proven, active LN patients and 24 SLE patients without active LN were enrolled and serial measurements were performed in 16 patients.

Results: Analysis of the urinary sediment in active renal disease showed an increased number of CD8+ T-cells and absence of these cells during remission. Enumerating T-cell counts in LN patients with a history of renal involvement was a superior marker of active LN in comparison to traditional markers, such as proteinuria and s-creatinine.

Conclusions: In conclusion, urinary T-cells, in particular CD8+ T cells, are a promising marker to assess renal activity in LN patients, in particular in those with prior renal involvement.

Show MeSH
Related in: MedlinePlus