4.7 Article

Urinary CD4 T cells identify SLE patients with proliferative lupus nephritis and can be used to monitor treatment response

Journal

ANNALS OF THE RHEUMATIC DISEASES
Volume 73, Issue 1, Pages 277-283

Publisher

BMJ PUBLISHING GROUP
DOI: 10.1136/annrheumdis-2012-202784

Keywords

Lupus Nephritis; Systemic Lupus Erythematosus; T Cells; Autoimmune Diseases; Inflammation

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Funding

  1. Deutsche Forschungsgemeinschaft [SFB 650]
  2. University Hospital Charite Berlin

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Objectives Proliferative lupus nephritis (LN) is one of the major concerns in the treatment of systemic lupus erythematosus (SLE). Here we evaluate urinary CD4 T cells as a biomarker of active LN and indicator of treatment response. Methods Urinary CD3CD4 T cells were quantified using flow cytometry in 186 urine samples from 147 patients with SLE. Fourteen patients were monitored as follow-up. Thirty-one patients with other nephropathies and 20 healthy volunteers were included as controls. Results In SLE, urinary CD4 T cell counts 800/100ml were observed exclusively in patients with active LN. Receiver operator characteristic analysis documented clear separation of SLE patients with active and non-active LN (area under the curve 0.9969). All patients with up-to-date kidney biopsy results showing proliferative LN had high urinary CD4 T cell numbers. In patients monitored under therapy, normalisation of urinary CD4 T cell counts indicated lower disease activity and better renal function. In contrast, patients with persistence of, or increase in, urinary T cells displayed worse outcomes. Conclusions Urinary CD4 T cells are a highly sensitive and specific marker for detecting proliferative LN in patients with SLE. Furthermore, monitoring urinary CD4 T cells may help to identify treatment responders and treatment failure and enable patient-tailored therapy in the future.

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