Chapter

Autoantibodies and lupus nephritis

Anisur Rahman, Jessica J. Manson and David A. Isenberg

in Lupus Nephritis

Second edition

Published on behalf of Oxford University Press

Published in print November 2010 | ISBN: 9780199568055
Published online November 2012 | e-ISBN: 9780191753374 | DOI: http://dx.doi.org/10.1093/med/9780199568055.003.0002

Series: Oxford Clinical Nephrology Series

Autoantibodies and lupus nephritis

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Lupus nephritis is a strikingly heterogeneous condition. This heterogeneity is exemplified in the role played by autoantibodies. Serological studies provide evidence that a number of different antibodies may be linked to the occurrence of renal involvement in patients with SLE, but some are only important in a small subset of patients. Anti-dsDNA antibodies are the most commonly seen antibodies in lupus nephritis, and those for which evidence of a pathogenic role is strongest. However, some anti-dsDNA negative patients have nephritis in association with anti-ssDNA or anti-Ro. Conversely, not all patients with high titers of anti-dsDNA develop nephritis. This shows that only a subset of anti-dsDNA antibodies are nephritogenic, and factors important in defining this subset are likely to include affinity, specificity, isotype, idiotype, and an ability to cross-react with cell-surface antigens. These nephritogenic antibodies can exert their effects on the glomeruli by different mechanisms. These include binding to DNA attached to collagen, binding to cell-surface proteins, and binding of anti-DNA/DNA/histone complexes to HS in the GBM. In any one patient, a number of different mechanisms may be operating and their relative importance is likely to vary from case to case. Thus, the task of finding a specific form of therapy directed against autoantibodies is a challenging one.

Chapter.  11885 words. 

Subjects: Nephrology

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