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Further description of early clinically silent lupus nephritis

Institute of Immunology (FOCIS Center), Central University School of Medicine, Caracas, Venezuela, zabaletm{at}ucv.ve

L E Muñoz

Institute of Immunology (FOCIS Center), Central University School of Medicine, Caracas, Venezuela

F J Tapanes

Institute of Immunology (FOCIS Center), Central University School of Medicine, Caracas, Venezuela

R E Vargas-Arenas

Institute of Immunology (FOCIS Center), Central University School of Medicine, Caracas, Venezuela

I Daboin

Institute of Pathology, Central University School of Medicine, Caracas, Venezuela

Y Barrios

Domingo Luciani Hospital, Central University School of Medicine, Caracas, Venezuela

J A Pinto

Institute of Pathology, Central University School of Medicine, Caracas, Venezuela

N E Bianco

Institute of Immunology (FOCIS Center), Central University School of Medicine, Caracas, Venezuela

Thirty silent lupus nephritis (SLN) patients were compared to 16 individuals bearing overt lupus nephritis (OLN). Results included: years of systemic lupus erythematosus (SLE) diagnosis were significantly earlier (4.6 ± 2.8 years) in SLN than in OLN (7.18 ± 3.61) (P < 0.05). Neurological compromise, hypertension, normocitic anemia and lymphopenia were significantly prevalent in OLN than in SLN (P < 0.05). Beside normal urinary sediment and renal function tests, the SLN group showed a moderate increase of both activity (AI) and chronicity (CI) renal pathology index when compared to highly increased AI and CI in OLN (P < 0.05). Seventy percent of SLN patients were ISN/RPS Classes I (6.6%) and II (63.3%) while 81% of OLN cases were Classes III, IV (37.5%) and V. IgG, IgA, IgM, chain, C3 and fibrinogen immune deposits were found in 90% or over in both SLN and OLN individuals while in 60% or over, both groups also showed K chain, C1q and C4 deposits. While prevalence of ANA, anti-dsDNA and anti-C1q antibodies were similar in both groups, anti-histone, anti-RNP, CIC and CH₅₀ serum levels were significantly different in OLN versus SLN (P < 0.05). We strongly suggest that indeed SLN is the earliest stage in the natural history of lupus nephritis.

Key Words: anti-C1q autoantibodies • overt lupus nephritis • silent lupus nephritis • systemic lupus erythematosus

Lupus, Vol. 15, No. 12, 845-851 (2006)
DOI: 10.1177/0961203306070002


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