Department of Nephrology, National Medical Center of the West, Mexican Social Security Institute, Guadalajara 44340, Jalisco, Mexico.
Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara 44360, Jalisco, Mexico.
Int J Mol Sci. 2024 Jun 27;25(13):7023. doi: 10.3390/ijms25137023.
Renal involvement is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE). The present study included patients with recently diagnosed Class III and Class IV lupus nephritis (LN) treated by Rheumatology who, upon the detection of alterations in their kidney function, were referred to Nephrology for the joint management of both medical specialties. The purpose of this study was to compare the plasma expression of Toll-Like Receptor 7 (TLR7) and TLR9 in healthy control (HC) subjects and newly diagnosed Class III and Class IV LN patients with 12-month follow-ups. The plasma expression of TLR7 and TLR9 proteins was determined by the ELISA method. A significant increase in the expression of TLR7 protein was found in Class III LN in the basal determination compared to the expression in the HC ( = 0.002) and at 12 months of follow-up ( = 0.03) vs. HC. The expression of TLR9 showed a behavior opposite to that of TLR7. TLR9 showed decreased protein expression in LN Class III patients' baseline and final measurements. The result was similar in the basal and final determinations of LN Class IV compared to the expression in HC. A significant decrease in SLEDAI -2K was observed at 12 months of follow-up in patients in Class III ( = 0.01) and Class IV ( = 0.0001) of LN. Complement C3 levels improved significantly at 12-month follow-up in Class IV patients ( = 0.0001). Complement C4 levels decreased significantly at 12-month follow-up in LN Class III compared to baseline ( = 0.01). Anti-DNA antibodies decreased significantly at 12 months of follow-up in Class IV LN ( = 0.01). A significant increase in proteinuria was found at 12 months of follow-up in Class III LN, compared to the baseline determination ( = 0.02). In LN Class IV, proteinuria decreased at 12 months of follow-up compared to baseline ( = 0.0001). Albuminuria decreased at 12 months of follow-up in LN Class IV ( = 0.006). Class IV LN, albuminuria also decreased at 12 months of follow-up ( = 0.009). Hematuria persisted in all patients and the glomerular filtration rate did not change. Three Class IV patients died before 12 months of follow-up from various causes. In conclusion, although the rheumatologic data appeared to improve, the renal function data remained inconsistent. Decreased expression of TLR9 and increased expression of TLR7 could be useful in the early diagnosis of Class III and Class IV LN is correct.
肾脏受累是红斑狼疮（SLE）患者发病和死亡的重要原因。本研究纳入了近期被诊断为 III 级和 IV 级狼疮性肾炎（LN）的患者，这些患者经风湿科治疗后，当肾功能出现异常时，将被转诊至肾内科，以便两个科室共同对患者进行治疗。本研究的目的是比较健康对照组（HC）与新诊断的 III 级和 IV 级 LN 患者在 12 个月随访时，血浆 Toll 样受体 7（TLR7）和 TLR9 的表达。采用 ELISA 法检测 TLR7 和 TLR9 蛋白的血浆表达。与 HC 相比，III 级 LN 患者在基础测定时 TLR7 蛋白表达显著增加（ = 0.002），在 12 个月随访时（ = 0.03）仍显著增加。TLR9 的表达与 TLR7 相反。III 级 LN 患者的 TLR9 蛋白表达在基线和最终测量时均降低。IV 级 LN 的基础和最终测定结果与 HC 相比也相似。在 III 级（ = 0.01）和 IV 级（ = 0.0001）LN 患者中，SLEDAI-2K 在 12 个月随访时显著降低。在 IV 级患者中，C3 补体水平在 12 个月随访时显著升高（ = 0.0001）。与基线相比，III 级 LN 患者的 C4 补体水平在 12 个月随访时显著降低（ = 0.01）。IV 级 LN 患者的抗 DNA 抗体在 12 个月随访时显著降低（ = 0.01）。与基线相比，III 级 LN 患者在 12 个月随访时蛋白尿显著增加（ = 0.02）。在 IV 级 LN 中，蛋白尿在 12 个月随访时较基线减少（ = 0.0001）。IV 级 LN 患者的白蛋白尿在 12 个月随访时减少（ = 0.006）。IV 级 LN 患者的白蛋白尿在 12 个月随访时也减少（ = 0.009）。所有患者均存在血尿，肾小球滤过率无变化。有 3 例 IV 级患者在 12 个月随访前因各种原因死亡。总之，尽管风湿学数据似乎有所改善，但肾功能数据仍不一致。TLR9 表达降低和 TLR7 表达增加可能有助于早期诊断 III 级和 IV 级 LN。
