Evaluating The Role of Serum Circulating Immune Complex Level in Lupus Nephritis Patients

Nada Hossam El Sayed El Issawi; Fahmy Alsayed  Abdelaziz; Ahmed Alaa- Eldin Ahmed  Saad; Mohamed Saeed  El Shorbagy

doi:10.55675/sjms.v3i6.121

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Published: 23-12-2024

DOI: https://doi.org/10.55675/sjms.v3i6.121

Keywords:

Immune complexes,, Systemic Lupus, , Nephritis, Disease Severity Index, Renal Biopsy

Nada Hossam El Sayed El Issawi

Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

Fahmy Alsayed Abdelaziz

Department of Clinical Pathology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

Ahmed Alaa- Eldin Ahmed Saad

Department of Internal Medicine (Nephrology Unit), Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Mohamed Saeed El Shorbagy

Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Abstract

Background: Systemic lupus erythematosus (SLE) is associated with significant multisystem complications. Lupus nephritis (LN) is one of the major complications. Circulating immune complexes (CIC) may represent a promising diagnostic biomarkers in LN. This study aimed to evaluate the role of serum circulating immune complexes in Lupus Nephritis and it’s relation to the renal biopsy.

Patients and Methods: Ninety subjects were included, 30 with systemic lupus with nephritis (group 1A), 30 with lupus without nephritis (Group 1B) and 30 healthy subjects. All were clinically evaluated and the value of laboratory measurements were recorded. The serum circulating of CIC were determined and correlated with other clinical and laboratory data as well as disease activity index. The assay of serum circulating immune complex level by quantitative Sandwich enzyme linked immunosorbent assay (ELIZA) technique. The assay of CIC was performed using a commercially available kits. The detection range was 2 to 600 ng/ml. The kit minimum detectable level of CIC was 1.765ng/ml.

Results: In group A, the results of the renal biopsy was class III LN among 13 patients and Class IV LN among 17 patients. The results of renal biopsy was significantly associated with anti-dsDNA, ESR, Activity index and urine total protein (TP), where anti-ds-DNA was significantly reduced and each of ESR, activity index and urine TP were significantly increased in class IV than class III (the mean values were 71.4 (IU/ml), 86.8 (mm/hour), 18.5, and 3.6 g/dl in class IV compared to 155.8, 69.4, 16.6 and 2.17 in class III, respectively). CIC was significantly correlated with activity index score in both 1A and 1B groups. CIC in discrimination SLE groups showed that, at value ≤ 84 (ng/ml) had a sensitivity, specificity, PPV, NPV of 100%, 100.0%, 100.0% and 100.0% respectively. Similar values were recorded for discrimination between 1B and control groups at a cutoff value of ≤ 189.

Conclusion: The CIC can be used as diagnostic and follow up biomarkers in the patients with systemic lupus wither with or without nephritis. It is specifically correlated with disease activity index.