Defective Fc Receptor-Mediated Function of the Mononuclear Phagocyte System in Lupus Nephritis

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Abstract
To determine whether patients with systemic lupus erythematosus and nephritis have more profound defects in mononuclear phagocyte system clearance than their counterparts without renal disease, Fc receptor-mediated splenic clearance function was studied in 32 patients. Clearance half-times [t1/2] were prolonged in patiens with lupus erythematosus compared with those in normal controls (P < 0.0001) and longer in patients with renal disese than in those without (P < 0.025). Both renal (.tau. = P < 0.45, P < 0.0002) and nonrenal (.tau. = 0.35, P < 0.003) disease activity were significantly but independently associated with clearance t1/2. When matched for nonrenal activity, patients with nephritis had greater clearance dysfunction than their counterparts without renal disase. Circulating immune complexes did not correlate with clearance for all patients. Neither HLA-B8 nor HLA-DR3 markers differentiated the renal and nonrenal disease subgroups. The greater Fc receptor-mediated clearance dysfunction, which occurs in patients with lupus erythematosus and nephritis, could lead to enhanced glomerular deposition of immune coplexes as a primary event, or as a secondary event amplifying previously established lesions.