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Antiphospholipid antibodies in pediatric lupus nephritis
S F Massengill1, C Hedrick, E M Ayoub
1Department of Pediatrics, University of Florida College of Medicine, Gainesville 32610-0296, USA.
Insights
In children with lupus nephritis, antiphosphatidylserine (APS) and antiphosphatidylinositol (API) antibodies did not predict thrombotic complications. Most pediatric patients with SLE nephritis had antiphospholipid antibodies (aPL), but these did not correlate with thrombosis risk.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Hematology
Background:
- Antiphospholipid antibodies (aPL) are associated with systemic lupus erythematosus (SLE).
- The role of specific aPL, such as antiphosphatidylserine (APS) and antiphosphatidylinositol (API) antibodies, in predicting thrombotic events in pediatric lupus nephritis is not well-defined.
Purpose of the Study:
- To investigate the association between aPL and thrombotic complications in children with lupus nephritis.
- To determine if APS and API antibodies predict thrombosis in this pediatric cohort.
Main Methods:
- Evaluated 36 children with lupus nephritis for IgG and IgM isotypes of APS, API, and anticardiolipin (ACL) antibodies using ELISA.
- Analyzed longitudinal data for antibody fluctuations and correlated aPL positivity with thrombotic events.
Main Results:
- 67% of patients had at least one positive aPL.
- Eight patients (22%) experienced thrombotic complications (arterial and venous).
- No significant difference in aPL positivity was found between patients with and without thrombotic events.
Conclusions:
- Neither APS, API, nor ACL antibodies were predictive of thrombotic complications in this cohort of pediatric patients with lupus nephritis.
- The presence of aPL in pediatric lupus nephritis does not appear to stratify thrombosis risk in this study population.
Abstract:
Antiphospholipid antibodies (aPL) of various isotypes are known to occur in systemic lupus erythematosus (SLE), but the significance of this finding in the pediatric population remains unclear. Our aim was to determine whether children with lupus nephritis have an increased risk of thrombosis and whether antiphosphatidylserine (APS) or antiphosphatidylinositol (API) antibodies were predictive of thrombotic complications. Thirty-six children (27 girls/9 boys; 44% black) with SLE nephritis (WHO II, 1; WHO III, 7; WHO IV, 21; WHO V, 7) were evaluated for antiphosphatidylserine, antiphosphatidylinositol, and anticardiolipin immunoglobulin (Ig) G and IgM isotypes, using a modified solid-phase enzyme-linked immunoassay (ELISA). Twenty-four patients (67%) had at least one positive aPL. Longitudinal data on 26 patients showed fluctuations in the degree of positivity. Eight patients experienced thrombotic complications, with equal distribution between arterial and venous events. Other clinical manifestations included thrombocytopenia in seven patients (19%), hemolytic anemia (44%), lupus anticoagulant (6%) and false-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 between the two groups. We conclude that neither APS, API, nor anticardiolipin (ACL) activity was predictive of thrombotic complications in our subset of patients with lupus nephritis.