Rheumatology Advance Access originally published online on June 19, 2009
Rheumatology 2009 48(8):1003-1007; doi:10.1093/rheumatology/kep152
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Immunohistochemical detection of intravascular platelet microthrombi in patients with lupus nephritis and anti-phospholipid antibodies
1Servicio de Reumatología, 2Unidad de Investigación, 3Servicio de Anatomía Patológica, Hospital 12 de Octubre, Madrid and 4Fundación Española de Reumatología, Sociedad Española de Reumatología, Madrid, Spain.
Correspondence to: María Galindo, Servicio de Reumatología, Hospital 12 de Octubre, Avenida de Córdoba sn, 28041 Madrid, Spain. E-mail: mgalindo{at}h12o.es
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Abstract |
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Objectives. To evaluate whether the use of platelet immunohistochemistry (IHC) markers improves the sensitivity of histological methods to detect microthrombosis in SLE nephritis and aPLs and to analyse the clinicopathological correlations of microthrombosis in this setting.
Methods. Kidney biopsy specimens from 65 patients with SLE, including 36 with positive aPLs, were studied by IHC using antibodies against platelet glycoproteins CD41 and CD61. Clinical data at the time of kidney biopsy and during a mean follow-up of 7.5 years after biopsy were recorded and analysed with regard to histological or IHC data.
Results. Histological lesions previously defined as APS nephropathy were found in 33% of the SLE kidney biopsies and were not associated with positive aPLs. Microthrombi detected as intravascular CD61+ platelet deposits were present in 43% of the tissues and were significantly associated with positive aPLs, but not with histological APS nephropathy, nephritis manifestations nor with renal outcome. Histological APS lesions but not CD61+ microthrombi correlated with an older age at nephritis presentation, previous cardiovascular risk factors and worse renal outcome.
Conclusions. Immunodetection of intravascular CD61+ platelet aggregates is more sensitive than histological evaluation to detect acute microthrombosis and provides a better correlation with aPLs in SLE patients. In contrast, histological lesions consistent with APS nephropathy were not associated with aPLs but with cardiovascular risk factors and worse renal outcome.
KEY WORDS: Anti-cardiolipin antibodies, Anti-phospholipid antibodies, Anti-phospholipid syndrome, Lupus nephritis, Systemic lupus erythematosus
Submitted 21 February 2009;
revised version accepted 13 May 2009.
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