Markers of childhood lupus nephritis indicating disease activity

Current treatment regimens for childhood lupus nephritis (LN) are associated with significant side-effects and toxicity in vulnerable phases of growth and development. The paucity of biomarkers particularly in childhood impedes the appropriate clinical management and the development of new therapeutics. We analyzed markers of immune system (BAFF, RANTES), complement (Bb, C1q, C3d-CIC, C5a) and endothelial cell activation (sVCAM-1) in children with LN ( n = 22, mean age 14.8 ± 4.7 years), nephrotic syndrome ( n = 13) and age-matched healthy controls ( n = 20) to define parameters that correlate with LN activity. Complement fragments of the alternative (Bb, p = 0.0004) classical (C3d-CIC, p < 0.0001) and common pathway (C5a, p < 0.0001) and the levels of BAFF ( p < 0.0001), RANTES ( p = 0.0002) and sVCAM-1 ( p = 0.0004) were significantly higher in active compared to inactive LN. Activation of complement was associated with the occurrence of anti-C1q antibodies and reduced complement C1q. Complement-activation fragments highly correlated with the markers for immune system and endothelial cell activation. The ensemble of these parameters may be of great value in identifying early flares or remissions of childhood LN, and moreover may prove useful in the assessment of new treatments and in determining the optimization of their use.