scholarly journals Characteristics and Histological Types of Lupus Nephritis in a Jordanian Tertiary Medical Center

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Randa I. Farah ◽  
Ebtesam Dannoun ◽  
Nisreen Abu Shahin ◽  
Saif Aldeen AlRyalat
Keyword(s):  
Lupus Nephritis ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Class Iii ◽  
Laboratory Findings ◽  
Histological Types ◽  
Nephritic Syndrome ◽  
Significant Difference ◽  
Stage Renal Disease ◽  
Class Iv

Objectives. Few reports of lupus nephritis (LN) from Jordan and the Middle East exist. This study assessed the demographic, clinical, and basic laboratory characteristics of Jordanian patients with LN and correlations with the histological class of LN. Methods. This was a retrospective study of all patients who underwent kidney biopsy between 2007 and 2018 at a tertiary medical center in Jordan. Patients’ demographic, clinical, laboratory, and pathological data were reviewed. Results. In total, 79 patients were included in this study [mean age, 29.95 ± 12.16 years; 11 men (13.9%), 68 women (86.1%)]. Asymptomatic proteinuria and hematuria were the most common presentations in LN patients at biopsy (59.5%). The study revealed a significant difference in frequency of nephritic syndrome (p= 0.01) between sexes (10.3% female vs. 45.5% male). Class IV was the most common pathological class of LN [37 (46.8%)], followed by class V [15 (19%)] and class III [10 (12.7%)]. Post hoc analysis of the associations between laboratory values and histopathological patterns revealed a significant correlation between class IV lupus and renal failure (p= 0.018) and class IV lupus and anti-DNA antibodies p= 0.030). End-stage renal disease (ESRD) occurred in 25% of lupus nephritis cases. There was an increased likelihood of ESRD among men than women (45% vs. 22%). Overall mortality was 10%. Conclusion. Although some clinical and laboratory findings correlate with histological types of LN, clinical and laboratory parameters of Jordanian patients with LN are not predictive of the histological type, although differences with regional studies were noted.

scholarly journals Clinical Laboratory and Pathological Features Of Admitted Lupus Nephritis Patients

2013 ◽  
Vol 23 (2) ◽  
pp. 34-37
Author(s):  
Pradip Kumar Duttal ◽  
Pratik Chowdhury ◽  
Md Shafiul Haider ◽  
Satyajit Roy ◽  
Md Golam Faruk ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Clinical Features ◽  
Lupus Erythematosus ◽  
Clinical Laboratory ◽  
Class Iii ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Medical College ◽  
Age Range ◽  
Class Iv

Clinical features of Systemic Lupus Erythematosus (SLE) worsens when it involves kidneys. Even then in our socioeconomic context the patients who seek admission are usually at later stages. Moreover histological classes may not be previewed by clinical and laboratory features. The aim of the study is to show variation of clinical features and laboratory findings in relation to pathological classes of Lupus nephritis. It was a cross sectional descriptive study enrolling 30 female patients admitted in medicine and nephrology department of Chittagong Medical College. Majority of the patients are of age range 21-40 years (73%); belonging to middle class family (90%) and educated upto level of secondary school certificate (43%). Oedema (93%), normotension (73%) and anaemia (93%) are common clinical features. Though all patients had macroscopic proteinuria only 20 % patients had massive proteinuria (>3gm%). Serologically Nineteen patients are ANA positive (63%) and all patients had Anti-dsDNA positivity. Class III and Class IV comprises 70% of patients. Estimated Glomerular filtration rate (eGFR) is more in class V ( mean 77.77) and class III (mean 76.86) than class II ( mean 52.67) and class IV ( mean 59.95) signifying eGFR cannot estimate severity. In conclusion without renal biopsy Lupus nephritis class cannot be ascertained and so class specific management cannot be given. JCMCTA 2012 ; 23 (2): 34-37

scholarly journals Urinary epidermal growth factor as a marker for lupus nephritis: clinical, laboratory, and histopathological study

2021 ◽  
Vol 48 (1) ◽  
Author(s):  
Hesham M. Hefny ◽  
Esam M. Abualfadl ◽  
Emad A. M. Youssef ◽  
Mohamed Ali Ismail ◽  
Tamer M. Soliman ◽  
...  
Keyword(s):  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Lupus Nephritis ◽  
Clinical Laboratory ◽  
Urinary Protein ◽  
Histopathological Study ◽  
Creatinine Ratio ◽  
Class Iii ◽  
Significant Difference ◽  
Epidermal Growth

Abstract Background Lupus nephritis can be seen in up to 60% of all SLE patients with 10–15% of nephritis patients progressing to end-stage renal disease; late diagnosis of lupus nephritis is correlated with a higher frequency of renal insufficiency. The study aim is determination of the value of urinary human epidermal growth factor (urinary EGF) as an early biomarker of lupus nephritis in SLE patients and its relevance to disease activity and renal histopathology. Results The study included 58 SLE patients and 30 healthy controls; a significant difference was noticed between SLE and controls in urinary protein, creatinine, protein/creatinine ratio, and urinary EGF. The mean level of urinary EGF was less in classes IV and V renal nephritis than in classes I, II, and III. There is a significant difference in urinary EGF (33±29, 27±16, P = 0.04) between class II and class III lupus nephritis, with no significant differences in urinary protein, creatinine, protein/creatinine ratio, and SLEDAI. On the other hand, the comparison between classes II and IV showed significant difference not only in urinary EGF (33±29, 11.7±4.9 m, P=0.003), but also in SLEDAI (37.4±8, 70.5±27, P= 0.007), and protein/creatinine ratio (0.98±0.62, 3±1.8, P=0.006). Conclusion This study raises the attention to test the sensitivity of urinary EGF in detecting the early and the subsequent changes in renal pathology of SLE patients as an easy, non-invasive, accurate, cheap marker that could help in following up the nephritis progression and adjusting the plan of treatment; also, it can be used to guide the time of biopsy or as an alternative in cases where renal biopsy is contraindicated.

scholarly journals Lupus Nephritis: Role of Serum Complement Levels as Prognostic Marker

2020 ◽  
Vol 6 (1) ◽  
pp. 01-05
Author(s):  
Richmond Gomes
Keyword(s):  
Lupus Nephritis ◽  
Treatment Response ◽  
Lupus Erythematosus ◽  
Serum Complement ◽  
Class Iii ◽  
Proliferative Lupus Nephritis ◽  
Significant Difference ◽  
Before And After ◽  
Assess Treatment Response ◽  
Serological Biomarkers

Background: Lupus Nephritis (LN) is one of the most common and serious manifestations in Systemic Lupus Erythematosus (SLE) patients that causes significant morbidity and mortality. Certain biomarkers for LN are sometimes able to assess treatment response of lupus nephritis. Objective: To compare serum complement levels (C3 & C4) as markers of treatment response of LN and their relation to the LN class in renal biopsy. Methods: This prospective observational study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2018 to August 2019. Twenty seven patients who were diagnosed with lupus nephritis after kidney biopsy were included in this study. Serum complement levels (C3 & C4), 24 hours urinary total protein (24-hr UTP) and anti-double-stranded DNA (anti-ds DNA) were measured in all patients at baseline, 3 months and 6 months after treatment. These biomarker values before and after treatment were compared between the treatment response and non response groups. Results: Serum C3 levels were significantly different in patients of proliferative lupus nephritis (Class III & Class IV) than non proliferative lupus nephritis (Class V) at baseline (0.47 ± 0.32 vs0.89 ± 0.43g/l, p = 0.009) and levels changed significantly 6 months after treatment (p <0.001) and likewise for Serum C4 levels (0.10 ± 0.06 vs0.24 ± 0.26g/l, p = 0.040). Serum C3 levels were also found to correlate significantly with SLEDAI and renal SLEDAI. No significant difference was observed for 24-hr UTP levels at baseline between remission and non-remission groups. Conclusion: Serum C3 & C4 levels may be utilized as serological biomarkers to predict and monitor the treatment response of lupus nephritis.

scholarly journals Change of Renal Gallium Uptake Correlated with Change of Inflammation Activity in Renal Pathology in Lupus Nephritis Patients

2021 ◽  
Vol 10 (20) ◽  
pp. 4654
Author(s):  
Tsu-Yi Hsieh ◽  
Yi-Ching Lin ◽  
Wei-Ting Hung ◽  
Yi-Ming Chen ◽  
Mei-Chin Wen ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Left Kidney ◽  
Renal Pathology ◽  
Class Iii ◽  
Stage Renal Disease ◽  
End Stage ◽  
Active Inflammation ◽  
Histological Results

Background: Lupus nephritis (LN) often lead to end-stage renal disease in systemic lupus erythematosus patients. This study aimed to investigate the clinical application of renal gallium-67 scans for determining renal histological parameters in LN patients. Methods: Between 2006 and 2018, 237 biopsy-proven and 35 repeat biopsies LN patients who underwent renal gallium scans before or after biopsy were included for analysis. The classification and scoring of LN were assessed according to the International Society of Nephrology/Renal Pathology Society. A delayed 48-h gallium scan was performed and interpreted by semiquantitative methods using left kidney/spine (K/S) ratio. The renal histological results were compared with gallium uptake. Results: Out of 237 participants, 180 (76%) had proliferative LN. Baseline gallium left K/S ratio was significantly higher in class IV LN as compared to class III (median (interquartile range, IQR): 1.16 (1.0–1.3), 0.95 (0.9–1.1), respectively, p < 0.001). Furthermore, changes in gallium uptake between two biopsies were positively correlated with changes activity index (r = 0.357, p = 0.035), endocapillary hypercellularity (r = 0.385, p = 0.032), and neutrophils infiltration (r = 0.390, p = 0.030) in renal pathology. Conclusions: Renal gallium uptake is associated with active inflammation in LN. Changes in renal gallium uptake positively correlated with changes in activity index in renal pathology.

scholarly journals Does Pulmonary Embolism Differ Between Genders in Terms of Clinical, Laboratory Findings, Prognosis and Mortality?

2020 ◽  
Author(s):  
Damla Serçe Unat ◽  
Aysu Ayrancı ◽  
Gulru Polat ◽  
Gülistan Karadeniz ◽  
Fatma Demirci Üçsular ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Laboratory ◽  
Severity Index ◽  
Early Mortality ◽  
European Respiratory Society ◽  
Laboratory Findings ◽  
Significant Difference ◽  
Male Patients ◽  
European Society Of Cardiology

INTRODUCTION: Pulmonary thromboembolism (PTE) is a disease that mortal and hardly diagnosed. Since findings of PTE are nonspesific diagnosed can be so hard sometimes. Major risk factors are malignancy, immobility, previous surgery, thrombophilia, advanced age, and genetic factors. Studies on the relationship between gender and prognosis in PTE have very different results. In this study, we aimed to evaluate gender differences in terms of prognosis, intensive care admission, laboratory, and radiological tests. METHODS: We retrospectively analyzed the data of 348 patients diagnosed with Acute PTE between January 2012 and December 2015. All of these patients were patients who applied to the emergency department of our center, which is a third step chest diseases hospital. We used the PTE guideline jointly designed by the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) for prognosis classifications. RESULTS: The mean age of the patients was 62.7, while the male patients were younger. Women's sPESI scores and mean ages were observed higher than men. Although women had more bad prognostic factors, no significant difference was found between both genders in terms of early mortality. DISCUSSION AND CONCLUSION: Although there is a difference between mean age and simplified Pulmonary Embolism Severity Index (sPESI) scores; no difference in early mortality between men and women. Gender studies in PTE are an area that is open to new studies, since the studies conducted on this subject give quite different results and these results may affect the follow-up protocols.

A Team-Based Approach to Autopsy Education: Integrating Anatomic and Clinical Pathology at the Rotation Level

2014 ◽  
Vol 138 (3) ◽  
pp. 322-327 ◽  
Author(s):  
Tiffany Michele Hébert ◽  
Sara Maleki ◽  
Ljiljana V. Vasovic ◽  
Jeffrey L. Arnold ◽  
Jacob J. Steinberg ◽  
...  
Keyword(s):  
New York ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Clinical Pathology ◽  
Holistic Approach ◽  
Final Diagnosis ◽  
Perceived Usefulness ◽  
Final Report ◽  
Laboratory Findings ◽  
Depth Analysis

Context.—Pathology residency training programs should aim to teach residents to think beyond the compartmentalized data of specific rotations and synthesize data in order to understand the whole clinical picture when interacting with clinicians. Objective.—To test a collaborative autopsy procedure at Montefiore Medical Center (Bronx, New York), linking residents and attending physicians from anatomic and clinical pathology in the autopsy process from the initial chart review to the final report. Residents consult with clinical pathology colleagues regarding key clinical laboratory findings during the autopsy. This new procedure serves multiple functions: creating a team-based, mutually beneficial educational experience; actively teaching consultative skills; and facilitating more in-depth analysis of the clinical laboratory findings in autopsies. Design.—An initial trial of the team-based autopsy system was done from November 2010 to December 2012. Residents were then surveyed via questionnaire to evaluate the frequency and perceived usefulness of clinical pathology autopsy consultations. Results.—Senior residents were the most frequent users of clinical pathology autopsy consultation. The most frequently consulted services were microbiology and chemistry. Eighty-nine percent of the residents found the clinical pathology consultation to be useful in arriving at a final diagnosis and clinicopathologic correlation. Conclusion.—The team-based autopsy is a novel approach to integration of anatomic and clinical pathology curricula at the rotation level. Residents using this approach develop a more holistic approach to pathology, better preparing them for meaningful consultative interaction with clinicians. This paradigm shift in training positions us to better serve in our increasing role as arbiters of outcomes measures in accountable care organizations.

scholarly journals Clinical and Morphologic Differences between Class IV-S and Class IV-G Lupus Nephritis

2011 ◽  
Vol 2011 ◽  
pp. 1-5
Author(s):  
Daniela Monova ◽  
Simeon Monov ◽  
Todor Todorov
Keyword(s):  
Blood Pressure ◽  
Lupus Nephritis ◽  
Complex Disease ◽  
Laboratory Data ◽  
Fibrinoid Necrosis ◽  
Immune Complex Disease ◽  
Significant Difference ◽  
Combined Lesions ◽  
Class Iv

Introduction. The new ISN/RPS classification of lupus nephritis (LN) divides diffuse proliferative LN into two subcategories with predominantly segmental proliferative lesions (class IV-S) and with predominantly global proliferative lesions (class IV-G). This paper explores the validity of this distinction and possible differences between the two types of lesions. Patients and Methods. A retrospective analysis of biopsy-proven cohort of 231 patients with LN was performed. Clinical and laboratory data were available on all patients selected. Results. The prevalence of Class IV was 27,27% (41 patients had class IV-S, 22-class IV-G). The serum creatinine levels, proteinuria, and diastolic blood pressure were significantly greater in the IV-G class, but haemoglobin was significantly lower. Histologically combined lesions with segmental endocapillary proliferation and fibrinoid necrosis were more frequent in the class IV-S. No significant difference was detected in outcomes in the two groups after followups of 145,2 ± 76,87 months. Conclusions. There are definite clinical and morphologic differences between class IV-S and IV-G lesions. Data suggest that class IV-G lesions behave as an immune complex disease; however, in class IV-S lesions, the presence of proportionally greater glomerular fibrinoid necroses suggests that these lesions may have a different pathogenesis.

Clinical and Epidemiologic Features of Visceral Leishmaniasis in Children: A 6-year Study from an Iranian Referral Hospital

2020 ◽  
Vol 20 (4) ◽  
pp. 461-466 ◽  
Author(s):  
Mohamadreza Abdolsalehi ◽  
Babak Pourakbari ◽  
Shima Mahmoudi ◽  
Mina Moradzadeh ◽  
Hossein Keshavarz ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Final Diagnosis ◽  
Laboratory Findings ◽  
Center Hospital ◽  
Regional Disease ◽  
Loss Of Appetite ◽  
And Control ◽  
Epidemiologic Features

Background:: Visceral leishmaniasis (VL) is an emerging zoonosis disease that is endemic in the northwestern and southern part of Iran. This study aimed to evaluate the clinical characteristics and laboratory findings of the children with VL hospitalized at Children Medical Center Hospital (CMC), Tehran, Iran. Methods:: A retrospective study was performed based on studied medical records of children with a final diagnosis of VL from 2011 to 2016. For each patient’s demographics, clinical laboratory findings and treatment were examined. Results:: The clinical features of 17 children were examined and the most frequent symptoms were fever (94.1%, n=16), pallor, loss of appetite (76.5%, n=13), splenomegaly (82.4%, n=14) and hepatomegaly (58.8%, n=10). The most frequent laboratory abnormalities were hematological including anemia (94.1%, n=16), leukopenia (52.9%, n=9) and thrombocytopenia (70.5%, n=12). In order to detect anti-Leishmania antibodies, DAT was performed in 11 patients and 82% of them were positive (titers ≥ 1: 3200). In addition, rK39 was used in 9 cases and 7 children (78%) had positive results. Direct parasitology revealed the presence of amastigotes of Leishmania in bone marrow aspirate (BMA) stained by Giemsa stain in 9 patients (69%, among 13 children). Conclusion:: Leishmaniasis is a regional disease therefore management and control of disease, particularly in an endemic area, as well as detection of new emerging foci are recommended.

Renal outcome after kidney-transplantation in Korean patients with lupus nephritis

Lupus ◽  
2017 ◽  
Vol 27 (3) ◽  
pp. 461-467 ◽  
Author(s):  
E S Park ◽  
S S Ahn ◽  
S M Jung ◽  
J J Song ◽  
Y-B Park ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Kidney Transplantation ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Graft Failure ◽  
Renal Outcome ◽  
Class Iii ◽  
Systemic Lupus ◽  
Renal Flare ◽  
Class Iv

We investigated renal outcome of kidney-transplantation in 19 Korean recipients with biopsy-proven lupus nephritis and compared it with 18 Korean age- and gender-matched recipients without lupus nephritis who were diagnosed with end-stage renal disease caused by renal diseases other than lupus nephritis in a single centre. We reviewed histological findings of kidneys and calculated cumulative dose of immunosuppressive agents. We assessed renal flare of systemic lupus erythematosus, recurrence of lupus nephritis and graft failure as prognosis. The mean age of recipients with lupus nephritis was 43.5 years and all patients were female. Six patients had class III, 10 had class IV and three had class V. There were no meaningful differences in demographic data, renal replacement modality, cumulative doses of immunosuppressants and prognosis between recipients with and without lupus nephritis. Eight patients experienced renal flare of systemic lupus erythematosus, but there were no cases of recurrence of lupus nephritis or graft failure in recipients with lupus nephritis. Kidney-recipients with class IV lupus nephritis exhibited a lower cumulative renal flare of systemic lupus erythematosus free survival rate than those with class III lupus nephritis. In conclusion, renal outcome of kidney-transplantation in patients with lupus nephritis is similar to that in those without lupus nephritis, and class IV was associated with renal flare of systemic lupus erythematosus.

scholarly journals P0351IMPACT OF APOL1 POLYMORPHISM ON LUPUS NEPHRITIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Carole Burger ◽  
KARRAS Alexandre
Keyword(s):  
Lupus Nephritis ◽  
Kidney Biopsy ◽  
Clinical Laboratory ◽  
African Ancestry ◽  
Collapsing Glomerulopathy ◽  
Kidney Involvement ◽  
Severe Chronic Kidney Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Abstract Background and Aims African ancestry is associated with more severe kidney involvement and end stage renal disease (ESRD) in lupus nephritis (LN). Two polymorphisms of the apolipoprotein L1 gene (APOL1), defining the risk allels (RA) G1 and G2, particularly frequent among subjects of African ancestry, markedly increase the risk of ESRD and the occurrence of collapsing glomerulopathy (CG) in the general population. The aim of this study was to assess the impact of ApoL1 RA on clinical, biological, and histological presentation of LN, and its prognosis. Method Patients of African ancestry with biopsy-proven LN were included between January 2017 and September 2018. Clinical, laboratory and pathology datas were retrospectively collected and ApoL1 genotyping was performed. Results Among the 53 included patients, 31 had no RA, 16 were heterozygous with only one RA and 6 had 2 RA (G1/G1 or G2/G2 or G1/G2). The population was divided in 2 groups: low risk polymorphism (LRP) group defined by the presence of 0 or 1 RA, and high risk polymorphism (HRP) group with 2 RA. At presentation, hypertension (OR 25,4 [1,3-510,3]) and acute renal failure (OR: 9,3 [1,3-65,2]), were more frequent in the HRP group when compared to the LRP group. Initial median serum creatinine was respectively 363 μmol/l (IQR 119-594) vs 64 μmol/l (IQR 55-127). After 2-year follow-up, median eGFR was 59mL/min (IQR 41-91) in the HRP group and 117mL/min (IQR 92-124mL/min) in the LRP group. Patients in the HRP group were more likely to have an impaired renal function with an estimated glomerular filtration rate (eGFR) &lt;60mL/min compared to patients in the LRP group (OR: 13,5 [2,1-86,5]). Moreover, ESRD-free survival was worse in the HRP group (Hazard ratio: 78,8 [5,3-1124,0]) despite similar chronicity indexes on initial kidney biopsy and comparable therapeutic strategies. As for histological findings, CG was observed in 67% of patient’s kidney biopsy in the HRP group whereas it only concerned 12% of patient’s kidney biopsy in the LRP group (OR: 14,8 [2,4-84,8]). Conclusion The ApoL1 polymorphism strongly affects LN prognosis in patients with African ancestry, resulting in more severe inaugural presentation, higher risk of subsequent severe chronic kidney disease and development of collapsing glomerulopathy for subjects with 2 RA.

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