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Urinary CD4 T cells identify SLE patients with proliferative lupus nephritis and can be used to monitor treatment response
  1. Philipp Enghard1,
  2. Claudia Rieder2,
  3. Katharina Kopetschke2,
  4. J R Klocke2,
  5. Reinmar Undeutsch2,3,
  6. Robert Biesen2,
  7. Duska Dragun1,
  8. Maik Gollasch1,
  9. Udo Schneider2,
  10. Karlfried Aupperle2,
  11. Jens Y Humrich2,
  12. Falk Hiepe2,
  13. Marina Backhaus2,
  14. A H Radbruch3,
  15. Gerd R Burmester2,
  16. Gabriela Riemekasten2
  1. 1Department of Nephrology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
  2. 2Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
  3. 3German Arthritis Research Center (DRFZ), a Leibnitz Institute, Berlin, Germany
  1. Correspondence to Dr Philipp Enghard, Department of Nephrology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz, Berlin 13353, Germany; Philipp.Enghard{at}Charite.de

Abstract

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 ≥800/100 ml 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.

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

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