Autoantibody cluster analysis in juvenile lupus nephritis.

Abstract

OBJECTIVE:

Demographics, clinical features, and biomarkers do not consistently anticipate risk of end-stage renal disease (ESRD) in juvenile lupus nephritis (LN). Here, the existence of autoantibody clusters predictive of ESRD was explored in a cohort of biopsy-proven juvenile LN.

METHODS:

A retrospective chart review was performed of patients with juvenile systemic lupus erythematosus (jSLE) and biopsy-confirmed LN. Primary endpoints were ESRD and mortality. Patients were included for K-medians cluster analysis if they had a complete autoantibody profile, which included ANA titer, anti-dsDNA, anti-Smith, anti-RNP, anti-Ro/SSA, anti-La/SSB. Chi-square test was used for categorical variables and one-way ANOVA for continuous measures. Significance was p<0.05.

RESULTS:

Fifty-three met inclusion criteria, of which 45 were female and 37 were black. Over 80% developed LN within one year of jSLE onset and more than half (n=29) had LN at diagnosis of jSLE. Six developed ESRD. No mortalities were reported. Forty-six had a complete autoantibody profile, including four with ESRD. Three clusters were identified. Group 1 (n=8) was defined by anti-dsDNA; group 2 (n=28) by high-titer ANA (>1:1280), anti-Smith, anti-RNP, and anti-Ro/SSA; and group 3 (n=10) by anti-dsDNA and anti-Ro/SSA. There was no difference between the groups in demographics, jSLE manifestations, or markers of renal function. One in group 2 and three in group 3 developed ESRD. Those in group 3 were younger at diagnosis of LN (p=0.084) and had the highest frequency of ESRD (p=0.025).

CONCLUSION:

Cluster analysis revealed the highest frequency of ESRD in the group with LN defined by anti-Ro/SSA and anti-dsDNA co-positivity. Key Points • Lupus nephritis commonly is present at diagnosis of juvenile systemic lupus erythematosus or develops within the first year. • End-stage renal disease was more frequent in the cluster defined by anti-dsDNA and anti-Ro/SSA co-positivity; patients with this profile may benefit from more aggressive immunosuppression.

• Authors: Matthew A Sherman, Amali Gunawardana, Janine P Amirault, Asha Moudgil, James E Bost, Sangeeta Sule, Hemalatha Srinivasalu
• Journal: Clinical rheumatology (Clin Rheumatol) Vol. 41 Issue 8 Pg. 2375-2381 (Aug 2022) ISSN: 1434-9949 [Electronic] Germany
• PMID: 35347489 (Publication Type: Journal Article)
• Copyright: © 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

Chemical References

• Antibodies, Antinuclear
• Autoantibodies
• Biomarkers
• DNA

Topics

• Antibodies, Antinuclear (analysis)
• Autoantibodies (analysis)
• Biomarkers
• Cluster Analysis
• DNA
• Female
• Humans
• Kidney Failure, Chronic (epidemiology)
• Lupus Erythematosus, Systemic (diagnosis)
• Lupus Nephritis (diagnosis)
• Male
• Retrospective Studies