ArticleLupus2010
The complex nature of serum C3 and C4 as biomarkers of lupus renal flare.
Article in Lupus, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 100 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
100 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- A systematic review and meta-analysis of the diagnostic accuracy of the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio in systemic lupus erythematosus.Clinical and experimental medicine · 2024Pooled it
- Medicinal Plant Extracts and Natural Compounds for the Treatment of Cutaneous Lupus Erythematosus: A Systematic Review.Frontiers in pharmacology · 2022Pooled it
- Predictive biological markers of systemic lupus erythematosus flares: a systematic literature review.Arthritis research & therapy · 2017Pooled it
- Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis.Annals of the rheumatic diseases · 2012Guideline
- A prospective study to compare the efficacy and safety of glucocorticoid-free maintenance therapy versus low-dose glucocorticoid maintenance therapy for lupus nephritis-a pilot, single-center, randomized controlled study.Clinical rheumatology · 2026Trial
- Advances in Complement Research: from Pathophysiology to Precision Medicine.Physiology (Bethesda, Md.) · 2026Review
- SLE Presenting With Unilateral Loculated Pleural Effusion in a Young Hypertensive Female: A Rare Case Report and Literature Review.Clinical case reports · 2026Article
- Prolonged serologically active clinically quiescent systemic lupus erythematosus: a longitudinal study on the role of IgG anti-dsDNA and C3.Rheumatology (Oxford, England) · 2026Article
- Biomarkers in the Management of Complement-Mediated Kidney Diseases in the Era of Complement Therapeutics.Clinical journal of the American Society of Nephrology : CJASN · 2026Review
- Systemic lupus erythematosus and pregnancy: a comprehensive clinical review of maternal, fetal, and treatment considerations.Advances in rheumatology (London, England) · 2026Review
- Elevated Serum Soluble Syndecan-1 Is Associated with Lupus Nephritis Flares: A Cross-Sectional Study.International journal of molecular sciences · 2026Article
- Complement Dysregulation in Kidney Diseases: Mechanisms, Biomarkers, and Emerging Targeted Therapies.International journal of molecular sciences · 2026Review
- Tjalma Syndrome-A Rare but Real Manifestation of Systemic Lupus Erythematosus.Clinical case reports · 2026Article
- Complement role in kidney disease: a comprehensive review and therapeutic innovations.BMC nephrology · 2026Review
- Complement-Mediated Kidney Diseases: Role of Alternative Pathway in Glomerular Inflammation.Kidney international reports · 2026Review
- Predictors of renal and patient survival in lupus nephritis: a 28-year single-center cohort study.Frontiers in nephrology · 2026Article
- Development and internal validation of a clinical nomogram for identifying lupus nephritis in patients with systemic lupus erythematosus.Frontiers in medicine · 2026Article
- Baseline neutrophil-to-lymphocyte ratio combined with SLEDAI predicts lupus low disease activity state at 1 year: a cohort study.Frontiers in immunology · 2026Article
- Correlation between serum complement component 4 levels and tubular atrophy in patients with lupus nephritis.Renal failure · 2025Article
- Article
40 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
Abstract
To assess the relationship between serum C3 or C4 levels and lupus renal flare, C3 and C4 levels were measured bimonthly in 71 lupus nephritis patients for a mean of 35 months, during which time 70 renal flares were identified. Comparing baseline, pre-flare, and at-flare values indicated that neither C3 nor C4 levels decreased pre-flare, but both decreased on average significantly at flare. However, sensitivity/specificity for C3 (75%/71%) and C4 (48%/71%) were low. To account for other influencing factors, multiple regression was performed that included bimonthly values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and genotype data on C3 (S/F), CRP (1846G > A), and the complement regulator factor H (Y402H). This analysis revealed that reduced levels of C4, but not C3, were independently associated with the two-month pre-flare period. Conversely, reduced levels of C3, but not C4, were independently associated with the flare visit. Significant pro-flare interactions included low C3 levels with the factor H 402HH-encoding genotype, and low CRP levels with the C3 F allele. Together these data suggest that C4 activation is critical for initiating renal flare while C3 activation is involved in the actual tissue damage, and that these effects are influenced by genetic variability in complement activation and regulation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.