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Abstract: TH-PO832

Angiotensin-II Type 1 Receptor Agonist Antibodies Are Prevalent in Lupus Nephritis Patients But May Have Limited Clinical Impact

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Mejia-Vilet, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
  • López hernández, Yesser Joel, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
  • Trujeque, Mariedel, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
  • Carranza, Carlos alberto, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
  • Santander, Jesus Ivan, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
  • Espinosa-González, Ricardo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
  • Uribe-uribe, Norma O., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
  • Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico, Mexico
Background

Angiotensin II type 1 receptor agonist antibodies (AT1R-AA) have been associated with hypertension, atherosclerosis and vascular inflamation in human diseases.

Methods

The aim of the study was to evaluate the prevalence of AT1R-AA in lupus nephritis (LN) and their association to hypertension and vascular damage. Eighty LN patients were evaluated by ambulatory blood pressure monitoring (ABPM), carotid Doppler ultrasound and renal biopsy vessel morphometry. AT1R-AA were evaluated in 112 kidney donors as a control group. AT1R-AA response to induction to remission therapy was followed for 6 months. Variables were compared by Fisher exact test or Kruskal-Wallis test. For correlations, serological titers were log-transformed and evaluated by Pearson test.

Results

Plasma AT1R-AA were positive in 45 (56.3%) and 23 (28.8%) had titers >250u/ml (Figure 1). AT1R-AA titers correlated with double-strand DNA antibodies' (dsDNA-Ab) titer (r=+0.651,p<0.001, Figure 1) and serum complement fragments C3 (r=-0.289,p=0.009) and C4 (r=-0.451,p<0.001). 77% of patients had an abnormal ABPM result, with 58% and 23% manifesting a diminished or absent dipping respectively. There was no association between AT1R-AA and ABPM blood pressure levels. Abnormal carotid intima-media thickness was found in 7.8%, with a trend for a greater CIMT in patients with the highest AT1R-AA titers. Subintimal fibrosis >10% was found in 46.3% of kidney biopsies. There was no association between AT1-AA titers and subintimal fibrosis. AT1R-AA response to treatment was evaluated in 40 patients. AT1R-AA titers course followed that of the dsDNA-Ab but was not associated with the response to treatment.

Conclusion

AT1R-AA are highly prevalent in lupus nephritis patients and closely correlate with serological activity but their pathogenic role is questionable. AT1R-AA cannot be recommended to be measured routinely.

A) AT1R-AA in kidney donors and LN patients. B) Correlation between AT1R-AA and dsDNA antibodies.

Funding

  • Government Support - Non-U.S.