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Copyright 2012. Nova Science Publishers, Inc. All rights reserved.

. May not be reproduced in any form without permission from the publisher, except fair uses permitted under 20 Ana Maria Abreu Velez and Michael S. Howard

D. Antiphospholipid Antibodies

These tests are associated with the important clinical issue of hypercoagulation [45,46].
Patients with high levels of antiphospholipid antibodies have an increased tendency to
clotting in both the veins and arteries; in pregnant women with these antibodies there is a risk
of thrombosis within the placenta and umbilical cord, leading to miscarriage [45-50].

E. Complement

The complement system represents a group of proteins in the blood which are involved in
the immune response. In active lupus, the levels of complement (usually measured as C3
and C4) are low; thus, levels of these proteins may provide an estimate of disease activity
[48-49]. Serum C3 and C4 levels have been used as biomarkers for lupus renal flares [50].
Further, recent studies have shown that complement anti-C1q antibodies levels have a higher
correlation with flares of lupus nephritis than other serum markers [51].

Blood Testing

In addition to the specific blood tests described above, the physician usually requests a
complete blood count (CBC) and serum chemistry studies. The blood count in lupus may
show a low white cell count, a low red cell count and a low platelet count. Serum chemistry
tests are also important, especially the blood creatinine and urea nitrogen measurements,
which are classically elevated in renal disease. Elevated blood C-reactive protein (CRP) may
also reflect lupus disease activity [52].

Urine Testing
Urine testing is vital in lupus patients; some lupus clinics teach all patients how to test
their own urine. The most simple test utilizes a dip-stick to check for elevated urine protein,
often the earliest clue to the presence of kidney disease. Following a positive dip stick test,
more precise urine tests are performed on a MSU (mid-stream urine) - a sample of urine
sent to the laboratory for microscopic analysis [53]. Under the microscope, the presence of
white cells, red cells or clumps of cells - casts - is recorded - all possible signs of kidney
disease. In addition,, urine sent to the laboratory may be tested for bacterial infection [53]. In
U.S. or applicable copyright law.

one study, the authors 1) determined the sensitivity and the specificity of the qualitative urine
dipstick test to detect 0.50 g or greater of a correlated quantitative 24-hour urine protein (24-
hUP), 2) addressed overall agreement of the dipstick test results and the magnitude of the 24-
hUP, and 3) examined the correlation between the spot urine protein creatinine index (S-
UPCI) and the 24-hour UPCI with that of the 24-hUP. The authors found that a 2+ dipstick
test is relatively sensitive to detect significant proteinuria, but it is poorly correlated with
quantitative 24-hUP. Further, the authors concluded that the S-UPCI and the 24-hUP can be
used interchangeably for follow-up in lupus nephritis patients with proteinuria of less than 2

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