Urinary mononuclear cell and disease activity of systemic lupus erythematosus

Abstract

Mononuclear cells play a cardinal role in the pathogenesis of systemic lupus erythematosus (SLE). A high urine cytology score has been reported to be associated with lupus nephritis in relapse. The objective of this study was to examine the urinary mononuclear cell population of patients with lupus nephritis, and explore its correlation with lupus disease activity. We studied 12 patients with active lupus nephritis, 17 patients with lupus nephritis in remission, 12 SLE patients with no history of renal disease and 13 healthy subjects. Clinical disease activity was quantified by the SLE Disease Activity Index (SLEDAI). Mononuclear cell species in the urinary sediment were examined by immunocytochemistry. Patients with active lupus nephritis had significantly more mononuclear cells in the urinary sediment. The number of + cell was significantly elevated in the active lupus nephritis than the others (P < 0.001), while there was no significant difference in the number of + and + cell among patient groups. The total urinary mononuclear cell correlated significantly with the overall SLEDAI score (r = 0.58, P < 0.001) as well as the renal score (r = 0.57, P < 0.001). The number of urinary +, but not + or +, cell significantly correlated with the overall SLEDAI score (r = 0.46, P = 0.003) as well as the renal score (r = 0.40, p < 0.011). In nine patients with renal biopsy, the histological activity index correlated with the total urinary mononuclear cell (r = 0.75, P = 0.02), + (r = 0.69, P = 0.04) and + cell (r = 0.69, P = 0.04). We conclude that urinary mononuclear cell was markedly elevated in patients with active lupus, and the urinary mononuclear cell count correlated significantly with the SLEDAI score and histological activity. + and + cells are the major component of urinary mononuclear cell in SLE patients and their number correlates with lupus disease activity.

Keywords

lupus nephritis lymphocyte NK cell urinalysis

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References

Horwitz DA , Jacob CO. The cytokine network in the pathogenesis of systemic lupus erythematosus and possible therapeutic implications . Springer Semin Immunopathol 1994; 16: 181-200 .

Houssiau FA. Management of lupus nephritis: an update . J Am Soc Nephrol 2004; 15: 2694-2704 .

Lewis EJ , Schwartz MM. Pathology of lupus nephritis . Lupus 2005; 14: 31-38 .

Balow JE. Clinical presentation and monitoring of lupus nephritis . Lupus 2005; 14: 25-30 .

Vitali C , Bencivelli W , Mosca M , Carrai P , Sereni M , Bombardieri S. Development of a clinical chart to compute different disease activity indices for systemic lupus erythematosus . J Rheumatol 1999; 26: 498-501 .

Sinico RA , Bollini B , Sabadini E , Di Toma L , Radice A. The use of laboratory tests in diagnosis and monitoring of systemic lupus erythematosus . J Nephrol 2002; 15 (Suppl 6): S20-S27 .

Hotta O , Taguma Y , Yusa N , Ooyama M. Analysis of mononuclear cells in urine using flow cytometry in glomerular diseases . Kidney Int Suppl 1994; 47: S117-S121 .

Hotta O , Yusa N , Ooyama M , Taguma Y. Urinary macrophage counts and ratio to T lymphocytes: possible use in differential diagnosis and management of glomerular disease . J Clin Lab Anal 1996; 10: 205-208 .

Krishna GG , Fellner SK. Lymphocyturia: an important diagnostic and prognostic marker in renal allograft rejection . Am J Nephrol 1982; 2: 185-188 .

10.

Anderson JB , Nobbs GL , Hammonds JC. Urinary cytology and the early detection of renal allograft rejection . J Urol 1986; 136: 10-12 .

11.

Segasothy M , Birch DF , Fairley KF , Kincaid-Smith P. Urine cytologic profile in renal allograft recipients determined by monoclonal antibodies . Transplantation 1989; 47: 482-487 .

12.

Roberti I , Dikman S , Spiera H , Reisman L , Eichenfield AH , Lieberman KV. Comparative value of urinalysis, urine cytology and urine sIL2R in the assessment of renal disease in patients with systemic lupus erythematosus (SLE) . Clin Nephrol 1996; 46: 176-182 .

13.

Yamamoto K , Okamura D , Kurahara D et al.

Do urinary mononuclear cells reflect disease activity in lupus nephritis?

Cell Mol Biol 2003; 49: 1333-1337 .

14.

Chan RW , Szeto CC. Advances in the clinical laboratory assessment of urinary sediment . Clin Chim Acta 2004; 340: 67-78 .

15.

Roberti I , Reisman L , Burrows L , Lieberman KV. Urine cytology and urine flow cytometry in renal transplantation - a prospective double blind study . Transplantation 1995; 59: 495-500 .

16.

Grunewald RW , Fiedler GM , Stock B , Grunewald JM , Muller GA. Immunocytological determination of lymphocytes and monocytes/macrophages in urinary sediments of renal allograft recipients . Nephrol Dial Transplant 2000; 15: 888-892 .

17.

Hochberg M. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum 1997; 40: 1725-1734 .

18.

Naoyuki T , Michiko S , Akihiro Y , Koji I. Elevated serum level of soluble HLA class I antigens in patients with systemic lupus erythematosus . Arthritis Rheum 1996; 39: 792-796 .

19.

Belmont HM , Levartovsky DG , Archana AA et al. Increased nitric oxide production accompanied by the up-regulation of inducible nitric oxide synthase in vascular endothelium from patients with systemic lupus erythematosus . Arthritis Rheum 1997; 40: 1810-1816 .

20.

Chan RW , Lai FM , Li EK et al. Imbalance of Th1/Th2 transcription factors in patients with lupus nephritis . Rheumatol (in press).

21.

Schiffenbauer J , Simon LS.

Randomized controlled trials in systemic lupus erythematosus: what has been done and what do we need to do?

Lupus 2004; 13: 398-405 .

22.

Chan RW , Chow KM , Tam LS et al.

Can urine dipstick test reduce the need of microscopy for the assessment of systemic lupus erythematosus disease activity?

J Rheumatol 2005; 32: 828-831 .

23.

Dooper IM , Bogman MJ , Hoitsma AJ , Maass CN , Vooijs PG , Koene RA. Immunocytology of urinary sediments as a method of differentiating acute rejection from other causes of declining renal graft function . Transplantation 1991; 52: 266-271 .

24.

Austin HA III , Boumpas DT , Vaughan EM , Balow JE. Predicting renal outcomes in severe lupus nephritis: Contributions of clinical and histologic data . Kidney Int 1994; 45: 544-550 .

25.

Grande JP , Balow JE. Renal biopsy in lupus nephritis . Lupus 1998; 7: 611-617 .

26.

Saikh KU , Lee JS , Kissner TL , Dyas B , Ulrich RG. Toll-like receptor and cytokine expression patterns of + T cells are similar to natural killer cells in response to infection with Venezuelan equine encephalitis virus replicons . J Infect Dis 2003; 188: 1562-1570 .

27.

Lanza F , Bi S , Castoldi G , Goldman JM. Abnormal expression of N-CAM (CD56) adhesion molecule on myeloid and progenitor cells from chronic myeloid leukemia . Leukemia 1993; 7: 1570-1575 .

28.

Agematsu K , Hokibara S , Nagumo H , Komiyama A. CD27: a memory B-cell marker . Immunol Today 2000; 21: 204-206 .

29.

Horwitz DA. Peripheral blood CD4+ T cells in systemic lupus erythematosus . Lupus 2001; 10: 319-320 .

30.

Odendahl M , Jacobi A , Hansen A et al. Disturbed peripheral B lymphocyte homeostasis in systemic lupus erythematosus . J Immunol 2000; 165: 5970-5979 .

31.

Jacobi AM , Odendahl M , Reiter K et al. Correlation between circulating CD27high plasma cells and disease activity in patients with systemic lupus erythematosus . Arthritis Rheum 2003; 48: 1332-1342 .

32.

Graber M , Lane B , Lamia R , Pastoriza-Munoz E. Bubble cells: renal tubular cells in the urinary sediment with characteristics of viability . J Am Soc Nephrol 1991; 1: 999-1004 .

33.

Madras PN , Simpson MA , Monaco AP. Monitoring the renal allograft by immunofluorescence of tubular epithelial cells in the urine sediment . Transplant Proc 1984; 16: 1583-1585 .

34.

Pefaur J , Trivino R , Navarrete C et al. Clinical graft evolution of lymphocytes, polymorphonuclear cells, and antigen expression in tubular renal cells in the urine sediment of 20 renal allograft recipients . Transplant Proc 2003; 35: 2500-2505 .

35.

Nakamura T , Ushiyama C , Suzuki S et al. Urinary podocytes for the assessment of disease activity in lupus nephritis . Am J Med Sci 2000; 320: 112-116 .

36.

Kewalramani R , Singh AK. Immunopathogenesis of lupus and lupus nephritis: recent insights . Curr Opin Nephrol Hypertens 2002; 11: 273-277 .