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

Item Type:	Article
Title:	Urinary CD4 T cells identify SLE patients with proliferative lupus nephritis and can be used to monitor treatment response
Creators Name:	Enghard, P. and Rieder, C. and Kopetschke, K. and Klocke, J.R. and Undeutsch, R. and Biesen, R. and Dragun, D. and Gollasch, M. and Schneider, U. and Aupperle, K. and Humrich, J.Y. and Hiepe, F. and Backhaus, M. and Radbruch, A.H. and Burmester, G.R. and Riemekasten, G.
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.
Keywords:	Biological Markers, CD4-Positive T-Lymphocytes, Cross-Sectional Studies, Drug Monitoring, Flow Cytometry, Follow-Up Studies, Immunosuppressive Agents, Lupus Nephritis, ROC Curve, Sensitivity and Specificity, Treatment Outcome, Urine
Source:	Annals of the Rheumatic Diseases
ISSN:	0003-4967
Publisher:	BMJ Publishing Group
Volume:	73
Number:	1
Page Range:	277-283
Date:	January 2014
Official Publication:	https://doi.org/10.1136/annrheumdis-2012-202784
PubMed:	View item in PubMed

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