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Are laboratory tests useful for monitoring the activity of lupus nephritis? A six year prospective study in a cohort of 228 lupus nephritis patients.
  1. Gabriella Moroni (gmoroni{at}
  1. Fondazione Ospedale Maggiore, Milano, Italy
    1. Antonella Radice (a.radice{at}
    1. Istitute of Microbiology, Azienda Ospedaliera San carlo Borromeo, Milano, Italy
      1. Gaia Giammarresi (gaiaqueen{at}
      1. Chair of nephrology, Palermo, Italy
        1. Silvana Quaglini (silvana.quaglini{at}
        1. Dipariemnto di Informatica e sistemistica, Univesita' degli studi di Pavia, Italy
          1. Beniamina Gallelli (beniamina.gallelli{at}
          1. Fondazione Ospedale Maggiore, Milano, Italy
            1. Antonio Leoni (antonio.leoni{at}
            1. Fondazione Ospedale Maggiore, Milano, Italy
              1. Maurizio Li Vecchi (m.livecchi{at}
              1. Chair of nephrology, University of palermo, Italy
                1. Piergiorgio Messa (pmessa{at}
                1. Fondazione Ospedale Maggiore, Milano, Italy
                  1. Renato Sinico (renato.sinico{at}
                  1. Renal Unit and clinical immunology Unit, Azienda ospedaliera San carlo Borromeo, Milano, Italy


                    Objectives: To evaluate the role of immunological tests for monitoring lupus nephritis (LN) activity.

                    Methods: C3, C4, anti-dsDNA and anti-C1q antibodies were prospectively performed over 6 years in 228 LN patients.

                    Results: In membranous LN only anti-C1q antibodies differentiated proteinuric flares from quiescent disease (p=0.02). However, in this group 46% of flares occurred with a normal value of anti-C1q antibodies versus 20% in proliferative LN (p=0.02). In patients with antiphospholipid antibodies (APL), 33% of flares occurred with normal levels of anti-C1q antibodies versus 14.5% in APL-negative patients (p=0.02). In proliferative LN, anti-C1q antibodies showed a slightly better sensitivity and specificity (80.5 and 71% respectively) than other tests for the diagnosis of renal flares. All 4 tests had good negative predictive value (NPV). At univariate analysis anti-C1q was the best renal flare predictor (p<0.0005). At multivariate analysis, the association of anti-C1q with C3 and C4 provided the best performance (p<0.0005,p<0.005,p<0.005 respectively).

                    Conclusions: Anti-C1q is slightly better than the other tests to confirm the clinical activity of LN, particularly in patients with proliferative LN and in the absence of APL. All 4 "specific" tests had a good NPV, suggesting that, in the presence of normal values of each, active LN is unlikely.

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                      BMJ Publishing Group Ltd and European League Against Rheumatism