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

Sebastian Dolff, Wayel H Abdulahad, Suzanne Arends, Marcory C R F van Dijk, Pieter C Limburg, Cees G M Kallenberg, Marc Bijl, Sebastian Dolff, Wayel H Abdulahad, Suzanne Arends, Marcory C R F van Dijk, Pieter C Limburg, Cees G M Kallenberg, Marc Bijl

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.

Figures

Figure 1
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 = **).
Figure 2
Figure 2
Receiver operator curve (ROC) analysis for proteinuria (g/24 h), serum creatinine, urinary CD4+ and CD8+ T-cells comparing SLE patients with active renal disease (n = 22) vs. patients without renal involvement (n = 14) (A). The same parameters are shown comparing patients with active LN (n = 22) vs. patients with a history of LN but without current renal activity (B). The area under the curve (AUC) is shown for all parameters.

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Source: PubMed

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