Types of autoantibodies that have been associated with CNS involvement in SLE

What are the types of autoantibodies that have been associated with CNS involvement in SLE

International Society of Nephrology and the Renal Pathology Society Classification of Renal Biopsies

ClassClinical ManifestationsHistology DescriptionLight MicroscopyEM or IF
I/Minimal mesangialNoneMesangial immune deposits by IF +/– EM
II/Mesangial proliferativeMicroscopic hematuria +/– proteinuria; rare HTNMesangial hypercellularity or mesangial matrix expansion; few subepithelial/subendothelial deposits by IF or EM
III/Focal
A = active lesions
C = chronic lesions
Hematuria and proteinuria +/– HTN, decreased GFR, or nephrotic syndrome<50% of glomeruli affected; IF almost uniformly involved; EM-immune deposits +/– mesangial area and in subendothelial space
Segmental proliferation wire loops
Note areas of cellular hyperproliferation and areas that are spared

Note mesangial deposits
IV/Diffuse
IV-S = segmental
IV-G = global
A = active lesions
C = chronic lesions
Hematuria, proteinuria (frequently nephrotic), cellular casts, and generally decreased GFR; HTN is common; Hypocomplementemia and elevated dsDNA also seen frequently>50% involvement of glomeruli; generalized hypercellularity of mesangial and endothelial cells; IF-full house pattern, extensive deposition; EM-immune complexes in both subendothelial and subepithelial distributions
Note hypercelluarlity of mesangial area and early formation of a crescent

Subendothelial deposits
Note dark areas proximal to the basement membrane which visually look like thickened loops on LM
V/MembranousExtensive proteinuria with minimal hematuria or renal function abnormalitiesGranular global or segmental subepithelial immune deposits by IF or EM Note thickened capillary loops without proliferation within the mesangial areas

Subepithelial deposits
Note dark areas distal to the basement membrane
VI/Advanced sclerosingChronic kidney disease>90% global glomerulosclerosis thought 2/2 lupus nephritis; no activity

EM, electron microscopy; GFR , glomerular filtration rate; HTN, hypertension; IF, immunofluorescence.Pathology slides courtesy of Patrick D. Walker, MD, Director of Arkana Laboratories.

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