ANTIPHOSPHOLIPID ANTIBODIES IN PEDIATRIC LUPUS NEPHRITIS

Antiphospholipid antibodies (aPL) of various isotypes are known to occ ur in systemic lupus erythematosus (SLE), but the significance of this finding in the pediatric population remains unclear. Our aim was to d etermine whether children with lupus nephritis have an increased risk of thrombosis and whether antiphosphatidylserine (APS) or antiphosphat idylinositol (API) antibodies were predictive of thrombotic complicati ons, Thirty-six children (27 girls/9 boys; 44% black) with SLE nephrit is (WHO II, 1; WHO III, 7; WHO IV, 21; WHO V, 7) were evaluated for an tiphosphatidylserine, antiphosphatidylinositol, and anticardiolipin im munoglobulin (Ig) G and IgM isotypes, using a modified solid-phase enz yme-linked immunoassay (ELISA), Twenty-four patients (67%) had at leas t one positive aPL, Longitudinal data on 26 patients showed fluctuatio ns in the degree of positivity, Eight patients experienced thrombotic complications, with equal distribution between arterial and venous eve nts, Other clinical manifestations included thrombocytopenia in seven patients (19%), hemolytic anemia (44%), lupus anticoagulant (6%) and f alse-positive Venereal Disease Research Laboratory (VDRL) test results (11%). Comparisons between those with and without a thrombotic event showed no detectable difference in the incidence of aPL positivity bet ween the two groups, We conclude that neither APS, API, nor anticardio lipin (ACL) activity was predictive of thrombotic complications in our subset of patients with lupus nephritis. (C) 1997 by the National Kid ney Foundation, Inc.