ASSOCIATION OF ANTICARDIOLIPIN ANTIBODIES WITH INTRAGLOMERULAR THROMBI AND RENAL DYSFUNCTION IN LUPUS NEPHRITIS

We studied positivity for anti-cardiolipin antibody, intraglomerular c apillary thrombi on renal biopsy, and the progression of renal disease in 51 patients (10 male and 41 female), mean age 37 years (range 17-6 5 years), with a diagnosis of systemic lupus erythematosis and clinica lly evident nephritis confirmed by renal biopsy. Serum creatinine, ser um indicators of disease activity and biopsies were analysed in subgro ups according to thrombi and anticardiolipin status. End-points were d eath or chronic dialysis requirement and survival. Degree of sclerosis , crescent formation and necrosed glomeruli were all greater in those specimens positive for thrombi and in those specimens of patients who were serum ACA-positive, suggesting a relationship to disease activity /severity at presentation. The increase in serum anti-DNA antibodies a nd ANA and the reduction in C3 and C4 were significant in ACA-positive patients, with a strong relationship to disease activity when compare d with changes in the ACA-negative patients (p<0.05 in all cases). The re was no significant difference when patients were separated accordin g to the presence or absence of thrombi. Renal function at presentatio n was worse in patients with intracapillary thrombi and ACA positivity (p=0.085 and p=0.042, respectively). All patients progressed, but onl y those with intracapillary thrombi or anti-cardiolipin antibody posit ivity had a significant deterioration in renal function. Twenty-one th rombotic episodes occurred in 14 patients, of whom 13 were ACA-positiv e. Anticardiolipin antibody is a strong predictor of the presence of i ntraglomerular thrombi in SLE patients with renal involvement. The pre sence of thrombi and/or anticardiolipin antibodies indicate a worse lo ng-term renal outcome. Anti-cardiolipin antibody positivity is a stron g predictor of systemic vascular thrombotic complications.