Background/Purpose: Clinical manifestations, pathohistology and treatment strategy are different between International Society of Nephrology/Renal Pathology Society (ISN /RPS) class III/IV and class V Lupus Nephritis (LN). However, it has remained unknown what factors contribute to differences of pathophysiology between ISN/RPS class III/IV LN and class V LN. Moreover, in some patients with class V LN, responses to treatment such as corticosteroid or immunosuppressive agents are refractory. Predictors for treatment response have remained unknown in class V LN. The aim of this study is to clarify the differences of autoantibody profile between ISN/RPS class III/IV LN and class V LN. We also investigate associations between clinical manifestations and each autoantibody in class V LN.

Methods: 55 LN patients were consecutively enrolled and underwent renal biopsy in this study. These patients were divided into two subsets, 31 patients with ISN/RPS class III/IV LN subset and 22 patients with class V LN subset. Combined class III/IV+ V LN cases were excluded in this study. Clinical manifestations, autoantibodies positivity (anti-dsDNA, anti-SS-A, anti-U1-snRNP, Anti-Sm and anti-ribosomal P) were compared between two subsets. In addition, we analyzed the relationship between clinical manifestation and each autoantibody in class V LN subset. 

Results: Disease duration was significantly longer in class III/IV LN than class V LN (P = 0.01). Anti-dsDNA titer was significantly higher in class III/IV LN than class V LN (P < 0.01). The frequency of anti-Sm and anti-ribosomal P positivity was higher in class V LN than class III/IV LN (43% vs 20% and 50% vs 25%, respectively), although there were no significant differences. The frequency of both anti-dsDNA positive and anti-U1snRNP negative was significantly higher in class III/IV LN than class V LN (54.1% vs 19.1%, P = 0.03). In contrary, the frequency of both anti-dsDNA negative and anti-U1snRNP positive was significantly higher in class V LN than class III/IV LN (33% vs 0%, P < 0.01). 

Among class V LN subset, complement levels were lower and renal remission rate was higher in anti-dsDNA-positive class V LN subset than anti-dsDNA-negative class V LN subset. SLEDAI score was significantly higher (P = 0.02) and 24hr proteinuria was higher in anti-Sm-positive class V LN subset than anti-Sm-negative class V LN subset. Rash and arthritis was higher in anti-ribosomal P-positive class V LN subset than anti-ribosomal P-negative class V LN subset.

Conclusion: Anti-U1snRNP is associated with complication of class V LN. Lower complement level and anti-dsDNA positivity are the predictive markers for renal remission in class V LN.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analysis-of-relationship-between-clinical-manifestations-and-autoantibody-profile-in-isnrps-class-v-lupus-nephritis/