Chapter

Lupus nephritis

Michael G. Robson

in Rheumatology and the Kidney

Second edition

Published on behalf of Oxford University Press

Published in print April 2012 | ISBN: 9780199579655
Published online February 2013 | e-ISBN: 9780191763472 | DOI: http://dx.doi.org/10.1093/med/9780199579655.003.0024

Series: Oxford Clinical Nephrology Series

Lupus nephritis

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1. A consideration of the complement system is important to those caring for patients with lupus, and for those seeking to understand the pathogenesis. 2. Low levels of C3 or C4, and anti-C1q antibodies are markers of disease activity in lupus. C1q antibodies are correlated with nephritis, but can occur without renal disease in a significant number of patients. 3. Normal levels of C3, C4 and anti-C1q antibodies strongly suggest clinically inactive disease, although abnormal levels may occur with both inactive and active disease. 4. Deposition of complement components in renal and skin biopsy tissue is characteristic of lupus. 5. Although the complement system has well documented proinflammatory functions, the evidence suggests that these may not be an essential part of the effector mechanisms causing tissue damage in lupus. However, the situation is not straightforward, and a proinflammatory role for complement is suggested by some experimental data. 6. Deficiencies of the early classical pathway are strongly associated with lupus, suggesting a protective role for complement. This may be due to defective clearance of immune complexes and/or apoptotic cells leading to increased autoantigen availability, and/or to effects on mechanisms of immunological tolerance.

Chapter.  4691 words.  Illustrated.

Subjects: Nephrology

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