How is systemic lupus erythematosus (SLE) disease activity assessed in lupus nephritis?

Updated: Mar 04, 2019
  • Author: Lawrence H Brent, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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SLE disease activity can be evaluated by assessing antibodies to double-stranded DNA (dsDNA), complement (C3, C4, and CH50), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels.

The CRP level is generally not elevated in patients with SLE, even with active disease, unless the patient has significant arthritis or infection. [26] Generally, elevated ESR and anti-dsDNA and depressed C3 and C4 levels are associated with active nephritis, especially focal and diffuse lupus nephritis. Clinically relevant lupus nephritis is associated with a 30% decrease in creatinine clearance, proteinuria of greater than 1000 mg/d, and renal biopsy findings indicating active lupus nephritis.

Anti-nucleosome antibodies appear early in the course of the autoimmune response in SLE, they have high sensitivity and specificity for a diagnosis of SLE, and the titers correlate with disease activity. [34, 35, 36] Anti-C1q antibodies are associated with lupus nephritis; higher titers correlate with active renal disease. [37, 38]

Anti-C1q antibodies have a sensitivity of 44-100% and a specificity of 70-92% in active renal disease (SLE); in combination with low C3 and C4 levels, these may be the predictors of renal flares in patients with SLE. [39] Although anti-DNA antibodies were more sensitive than anti-C1q antibodies for active lupus nephritis (75% vs 53%, respectively), anti-C1q antibodies were more specific (84% vs 49%, respectively); the negative predictive value of negative anti-DNA and anti-C1q antibodies for active lupus nephritis was 91%. [40]

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