Serum complement levels as prognostic marker for monitoring treatment response in lupus nephritis

Authors

  • Saiful Bahar Khan Assistant Professor, Department of Nephrology, Ad-din Women’s Medical College Hospital, Dhaka, Bangladesh
  • Rafi Nazrul Islam Senior Medical Officer, Department of Nephrology & Dialysis, BIRDEM General Hospital, Dhaka, Bangladesh
  • Md Saif Bin Mizan Assistant Professor, Department of Nephrology, Dr. Sirajul Islam Medical College, Dhaka, Bangladesh
  • AKM Shahidur Rahman Medical Officer, Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
  • Shah Md Zakir Hossain Medical Officer, Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
  • Shahida Mullah Junior Consultant, Department of Medicine, Sarkari Karmachari Hospital, Dhaka, Bangladesh
  • Sk Md Ershad Registrar, Department of Nephrology, National Institute of Kidney Diseases & Urology, Dhaka, Bangladesh
  • Tanvir Rahman Specialist, Department of Nephrology, United Hospital Limited, Dhaka, Bangladesh
  • Md Mustafizur Rahman Assistant Professor, Department of Nephrology, Sheikh Hasina Medical College, Tangail, Bangladesh
  • Salahuddin Feroz Junior Consultant (Nephrology), Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
  • Amir Mohammad Kaiser Assistant Professor, Department of Nephrology & Dialysis, Gonoshaystha Somazvittik Medical College and Gonoshaystha Nagar Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.3329/birdem.v11i2.53129

Keywords:

lupus nephritis, serum complements, systemic lupus erythematosus.

Abstract

Background: Lupus nephritis (LN) is one of the most common and serious manifestations of systemic lupus erythematosus (SLE) that causes significant morbidity and mortality. Certain biomarkers for LN are sometimes able to assess treatment response in lupus nephritis. This study aimed to compare serum complement levels (C3 and C4) as markers of treatment response of LN and their relation to the LN class in renal biopsy.

Methods: This prospective observational study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2018 to August 2019. Twenty seven patients who were diagnosed with LN after kidney biopsy were included in this study. Serum complement levels (C3 and C4), 24 hours urinary total protein (24-hr UTP) and anti-double-stranded DNA (anti-ds DNA) were measured in all patients at baseline, 3 months and 6 months after treatment initiation. These biomarker values before and after treatment were compared between the proliferative and non-proliferative LN patients.

Results: Serum C3 levels were significantly different between patients with proliferative LN (Class III and Class IV) and non-proliferative LN (Class V) at baseline (0.47 ± 0.32 g/l versus 0.89 ± 0.43 g/l, p=0.009) and levels changed significantly 6 months after treatment initiation (p<0.001) and likewise for serum C4 levels (0.10 ± 0.06 g/l versus 0.24 ± 0.26 g/l, p=0.040). The values of 24-hr UTP and anti-ds-DNA were significantly different 6 months after treatment with p value <0.05 in both groups but C3 (p<0.001) and renal Systemic Lupus Erythematosus Disease Activity Index (rSLEDAI) (p<0.001) were only significant in the proliferative group. On the other hand, after 6 months treatment, C4 levels became relatively higher but that was not significant in both groups (p>0.05).

Conclusion: After 6 months of treatment, serum C3 and C4 levels increased towards normal in both LN groups. Serum C3 and C4 levels in patients with LN correlate with disease activity. Therefore, serum complement (C3 and C4) levels may be utilized as serological biomarkers for treatment response of LN.

Birdem Med J 2021; 11(2): 97-102

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Published

2021-04-23

How to Cite

Khan, S. B., Islam, R. N., Mizan, M. S. B., Rahman, A. S., Hossain, S. M. Z., Mullah, S., Md Ershad, S., Rahman, T., Rahman, M. M., Feroz, S., & Mohammad Kaiser, A. (2021). Serum complement levels as prognostic marker for monitoring treatment response in lupus nephritis. BIRDEM Medical Journal, 11(2), 97–102. https://doi.org/10.3329/birdem.v11i2.53129

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