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Autoantibodies and lupus nephritis 

Autoantibodies and lupus nephritis
Chapter:
Autoantibodies and lupus nephritis
Author(s):

Anisur Rahman

, Jessica J. Manson

, and David A. Isenberg

DOI:
10.1093/med/9780199568055.003.0002
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date: 20 November 2019

Lupus nephritis is a strikingly heterogeneous condition. This heterogeneity is exemplified in the role played by autoantibodies. Serological studies provide evidence that a number of different antibodies may be linked to the occurrence of renal involvement in patients with SLE, but some are only important in a small subset of patients. Anti-dsDNA antibodies are the most commonly seen antibodies in lupus nephritis, and those for which evidence of a pathogenic role is strongest. However, some anti-dsDNA negative patients have nephritis in association with anti-ssDNA or anti-Ro. Conversely, not all patients with high titers of anti-dsDNA develop nephritis. This shows that only a subset of anti-dsDNA antibodies are nephritogenic, and factors important in defining this subset are likely to include affinity, specificity, isotype, idiotype, and an ability to cross-react with cell-surface antigens. These nephritogenic antibodies can exert their effects on the glomeruli by different mechanisms. These include binding to DNA attached to collagen, binding to cell-surface proteins, and binding of anti-DNA/DNA/histone complexes to HS in the GBM. In any one patient, a number of different mechanisms may be operating and their relative importance is likely to vary from case to case. Thus, the task of finding a specific form of therapy directed against autoantibodies is a challenging one.

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