Assessment of renal involvement in patients with systemic lupus erythematosus in a tertiary care hospital

Background: Renal involvement in SLE is common. Lupus Nephritis is the major cause of mortality in SLE patients. Renal involvement is a severe form of the disease and subsequent management is planned according to the histopathological class of lupus nephritis. Thus, this study was planned to assess the clinical profile and the extent of renal disease in SLE patients.Methods: A prospective observational study was conducted among SLE patients who got admitted in the Department of General Medicine and Nephrology in Thanjavur Medical College Hospital, Thanjavur from July 2012 to October 2013. Fifty SLE patients who had renal symptoms were included in this study.Results: SLE is Common among females. Common renal presentations were haematuria and proteinuria. 42% of the patients had Class IV lupus nephritis, followed by 24%, 16%, 16%, and 2% of Class III, II, Class V and Class I lupus nephritis respectively. No case of class VI lupus nephritis was reported in this study. ANA was positive among 66%, Anti ds DNA was positive in 64% and C3 level was found to be reduced in 50% of patients. Antiphospholipid antibodies were seen in 2% of the patients.Conclusions: Proteinuria, haematuria, a lower serum C3 level and need for aggressive hypertension management were prominently seen with a worse class of lupus nephritis. Patients with active and proliferative forms of lupus nephritis had a severe course of illness and required aggressive management with immunosuppressants.

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Presentation of Childhood Systemic Lupus Erythematosus in a Tertiary Care Hospital

Bangladesh Journal of Child Health ◽

10.3329/bjch.v38i3.22819 ◽

2015 ◽

Vol 38 (3) ◽

pp. 124-129

Author(s):

Shahana A Rahman ◽

Mohammad Imnul Islam ◽

Manik Kumar Talukder ◽

Mohammed Mahbubul Islam ◽

Syed Saimul Huque ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Tertiary Care ◽

Study Data ◽

Care Hospital ◽

Class Iii ◽

Systemic Lupus ◽

Presenting Symptoms ◽

General Weakness

Background: Systemic lupus erythematosus in children (Paediatric SLE / pSLE) may have a great variability in disease presentation. Any organ system can be involved in pSLE leading to protean clinical manifestations.To evaluate the clinical and serological presentation of pSLE in tertiary renter Bangladesh and to compare it with other populations. Methodology: It was a retrospective cohort study carried out in the department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of January 2005 to December 2013. A total of 70 patients fulfilling the 1997 revised ACR classification criteria for SLE were enrolled in the study. Data was collected in a pre-designed questionnaire. Results: Age range was 2.5 years to 16 years, female: male ratio was 7:1. Duration of disease was 1 month to 18 months. Common clinical presentation included general weakness/fatigue (91%), fever (83%), arthralgia/arthritis (74%), oral ulcer (73%) and skin rash (71%). All the patients were anemic. ANA was positive in 97% cases and anti-ds DNA in 91% cases. More than 65% cases had evidences of renal involvement at the presentation. Among the patients who underwent kidney biopsy, 40% had diffuse proliferative lupus nephritis (WHO class IV) followed by class III in 26% cases. Conclusion: Pediatric SLE patients in our country, compared to other countries had much higher incidence of fever and non-specific complaints such as, general weakness and malaise as presenting symptoms. Thus, a strong index of suspicion should be maintained for early diagnosis of pSLE especially among adolescent girls. DOI: http://dx.doi.org/10.3329/bjch.v38i3.22819 Bangladesh J Child Health 2014; VOL 38 (3) :124-129

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Interleukin-34 as a marker for subclinical proliferative lupus nephritis

Lupus ◽

10.1177/0961203320914976 ◽

2020 ◽

Vol 29 (6) ◽

pp. 607-616

Author(s):

Asmaa SM Abdel-Rehim ◽

Nesrine A Mohamed ◽

Marwa M Shakweer

Keyword(s):

Lupus Nephritis ◽

Lupus Erythematosus ◽

Activity Index ◽

Renal Involvement ◽

Clinical Manifestations ◽

Surrogate Marker ◽

Disease Activity Index ◽

Class Iii ◽

Group I ◽

Dsdna Antibodies

Background Lupus nephritis (LN) is an ominous manifestation of systemic lupus erythematosus (SLE). Clinical renal affection is present in about 70% of lupus patients, and more patients have histological evidence of renal involvement without clinical manifestations. This study aimed to investigate the potential role of serum interleukin-34 (IL-34) as an early marker for the detection of silent LN. Methods Thirty-three lupus patients with silent LN (group I), 37 patients with clinical LN (group II) and 20 controls were included. The SLE Disease Activity Index (SLEDAI), IL-34, anti-dsDNA antibodies and renal biopsy were assessed in all patients. Results Serum IL-34 levels were significantly higher in all lupus patients compared to healthy controls ( p < 0.001) and showed a significant positive correlation with SLEDAI score. SLE patients with positive anti-dsDNA antibodies had more active disease according to SLEDAI and higher levels of IL-34 than those with negative anti-dsDNA antibodies. In both studied groups, serum IL-34 levels were significantly higher in patients with proliferative LN (class III and class IV) than those with non-proliferative lupus (class II and class V) and controls. Yet, in both groups, IL-34 was not useful in differentiating active from chronic renal affection. Conclusion In lupus patients with insignificant proteinuria, serum levels of IL-34 distinguished the different histological classes of subclinical LN. Serum IL-34 may be used as a surrogate marker for early renal affection in silent LN, especially the proliferative type.

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Frequency of Class III and IV Nephritis in Systemic Lupus Erythematosus Without Clinical Renal Involvement: An Analysis of Predictive Measures

The Journal of Rheumatology ◽

10.3899/jrheum.110532 ◽

2011 ◽

Vol 39 (1) ◽

pp. 79-85 ◽

Cited By ~ 51

Author(s):

DAISUKE WAKASUGI ◽

TAKAHISA GONO ◽

YASUSHI KAWAGUCHI ◽

MASAKO HARA ◽

YUMI KOSEKI ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

High Titer ◽

Renal Involvement ◽

Renal Pathology ◽

Class Iii ◽

Systemic Lupus ◽

Clinically Normal ◽

Dsdna Antibody

Objective.To determine the frequency of International Society of Nephrology/Renal Pathology Society (ISN/RPS) class III or IV lupus nephritis in patients with systemic lupus erythematosus (SLE) without clinical renal involvement.Methods.We investigated the renal pathology of 195 patients with SLE, including 86 patients without clinical renal involvement.Results.Lupus nephritis other than class I was found in 58% of the patients without clinical renal involvement, and class III and IV nephritis was found in 15% of these patients. To reveal the predictive measures involved in class III or IV lupus nephritis, we explored the clinical measures in patients with SLE who did not have clinical renal involvement. Anti-dsDNA antibody titers were significantly higher (p = 0.0266) and C3 values were significantly lower (p = 0.0073) in patients with class III or IV lupus nephritis than in patients without class III or IV lupus nephritis. The sensitivity and specificity values were 77% and 73%, respectively, for cutoff levels of both 40 IU/ml for anti-dsDNA antibodies and 55 mg/dl for C3 (OR 8.8, p = 0.0011).Conclusion.The frequency of nephritis, including ISN/RPS class III and IV, was unexpectedly high in SLE patients without clinical renal involvement. ISN/RPS class III or IV lupus nephritis could be hidden in patients with SLE who present both a high titer of anti-dsDNA antibody and a low concentration of C3, even when they have clinically normal urinary findings and renal function.

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Autoantibodies spectrum in lupus nephritis in a cohort of Egyptian patients: relation to disease activity and prognostic value

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-020-00039-w ◽

2020 ◽

Vol 47 (1) ◽

Author(s):

Sahar A. Elsayed ◽

Omar M M. Mohafez

Keyword(s):

Lupus Nephritis ◽

Disease Activity ◽

Lupus Erythematosus ◽

Renal Involvement ◽

High Sensitivity ◽

Close Monitoring ◽

Class Iii ◽

Roc Curve Analysis ◽

Egyptian Patients ◽

The Impact

Abstract Background Specific autoantibodies are considered as an important marker in autoimmune rheumatic diseases and are of great value for the diagnosis and prognosis of systemic lupus erythematosus (SLE) patients. A total of eighteen autoantibodies were analyzed for their positivity in SLE patients and we evaluated the clinical relevance of the five most frequent autoantibodies: anti-dsDNA, anti-nucleosome, anti-histone, anti-Ro60, and anti-Ro52 on disease activity and renal affection in SLE Egyptian patients. Results Immunological profile and correlation of the five autoantibodies with disease activity and histopathological pattern of renal involvement were analyzed for 190 SLE patients. Lupus nephritis (LN) patients showed much worse constitutional and mucocutaneous manifestations than patients without nephritis. Autoantibody profile showed a significant increased frequency of anti-dsDNA, anti-nucleosome, anti-histone, anti-Ro-60, and anti-Ro52 antibodies in LN patients. The impact of the co-positivity of the autoantibodies on the renal function was obvious. Moreover, the disease activity increased by the increased frequency of autoantibodies positivity in LN patients. ROC curve analysis showed that anti-nucleosome had the highest sensitivity; 93% followed by anti-dsDNA 83.3% then anti-histone 73.8%, but anti-Ro60 and anti-Ro52 showed a humble sensitivity. Furthermore, the highest frequency of positivity for the five autoantibodies was found in class-III and class-IV LN patients. Conclusion Detection of anti-dsDNA, anti-nucleosome, anti-histone, and anti-Ro60 in SLE patients may be important for predicting disease progression and kidney affection. Moreover, anti-nucleosome and anti-dsDNA show high sensitivity and specificity for lupus nephritis, thus patients with four to five positive autoantibody panels should be kept under close monitoring as they may warrant considering aggressive therapy to control their disease and prevent renal damage.

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Clinical and investigational study for the aetiological evaluation of patients in nontraumatic altered sensorium and its outcome

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191309 ◽

2019 ◽

Vol 7 (4) ◽

pp. 1113

Author(s):

Siba Narayan Jali ◽

Sachida Nanda Nayak ◽

Biju K. Alexander ◽

Diptimayee Tripathy ◽

Bijaya K. Behera

Keyword(s):

Tertiary Care ◽

General Medicine ◽

Diagnostic Methods ◽

P Value ◽

Care Hospital ◽

College Hospital ◽

Metabolic Encephalopathy ◽

Altered Sensorium ◽

Medical College ◽

Gcs Score

Background: Apart from head injury many patients present to the tertiary care hospital in unconscious state, the etiology of which is obscure in most of the cases. The present study was conducted with on objective to provide insight into the clinical features and diagnostic methods to know the aetiology of patients with non-traumatic cases of altered sensorium and to study the outcome of these patients.Methods: This is an observational study on 100 patients of altered sensorium of non-traumatic origin during the period from October 2012 to September 2014 conducted in the Department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. All patients were selected for the study based on the inclusion exclusion criteria. Detailed history, clinical evaluation, laboratory investigations like neuroimaging studies etc. were carried out. Statistical data analysis was done using Graph pad Prism 6 and Microsoft Excel. P value <0.0001 was considered statistically extremely significant.Results: Out of 100 patients of altered sensorium, 64 were males and 36 were females. All patients were in the age group of 19 to 89 years. Cerebrovascular accident was the most common aetiology of altered sensorium followed by metabolic encephalopathy and infection. Altered sensorium in patients with CVA carries a high mortality. Metabolic causes and younger age indicated a better prognosis, patients with low (Glasgow Coma Score) GCS score of 3 to 4 had poorer prognosis.Conclusions: The results suggest that clinical assessments yield accurate predictive information about the potential for recovery in cases of altered sensorium. So, this study concludes that empirically based estimates of prognosis in the neurologically severely ill provides great reassurance to those involved in a decision-making process, including patients’ families and physicians.

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Drug utilization study in diabetic patients seeking medical treatment in a north Indian rural medical college hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20181634 ◽

2018 ◽

Vol 7 (5) ◽

pp. 912

Author(s):

Shweta Sharma ◽

S. C. Chopra ◽

D. K. Sharma ◽

Juhi Singla ◽

Vinod Kapoor

Keyword(s):

Chronic Disease ◽

Drug Utilization ◽

Demographic Data ◽

Tertiary Care ◽

General Medicine ◽

Essential Medicines ◽

Fixed Dose ◽

Diabetic Patients ◽

Care Hospital ◽

College Hospital

Background: Diabetes Mellitus is a chronic disease and its life-long management causes burden on lifestyle and financial condition of the patients. Drug utilization studies provide useful insights into the current prescribing practices.Methods: To evaluate the drug utilization pattern of anti-diabetic drugs in diabetic patients. A prospective observational study was carried out in adult diabetic patients visiting the Wards and Outpatient Department of General Medicine of a tertiary care hospital. The demographic data and utilization of different classes of anti-diabetic agents as well as individual drugs were analyzed.Results: In 125 patients (Male-65, Female-60), a total of 379 drugs (average 3.032±2.05) were used per day, out of which 76 (20.05%) were rational fixed dose combinations (FDCs) and 261 (68.86%) were prescribed from National List of Essential Medicines (NLEM) 2015. The number of drugs prescribed to be ingested was 326 (86.01%) and 63 (16.62%) were injectables.Conclusions: It was found that the prescription tendencies of the doctors were quite rational. More improvement can be done by sensitizing them to prescribe more drugs from NLEM. The limitations in the affordability of rural population should be taken care of while prescribing drugs for this chronic disease.

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Histopathological findings of renal biopsy in systemic lupus erythematosus

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v3i2.20268 ◽

2016 ◽

Vol 3 (2) ◽

pp. 10-14

Author(s):

Sanjit Karki ◽

Roshan Shrestha ◽

Buddhi Paudyal ◽

Bimal Pandey ◽

Nora Ranjitkar ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Renal Biopsy ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Definitive Treatment ◽

Class Iii ◽

Systemic Lupus ◽

Morphological Pattern ◽

Class Iv

Introductions: Classifying morphological pattern of renal involvement is important in systemic lupus erythematosus (SLE) for definitive treatment and prognosis. This study aims to analyse the histopathological pattern of glomerula in SLE patients.Methods: This was a retrospective chart review of patients diagnosed with SLE who had renal biopsy during October 2013 to September 2015 at Patan Hospital.Results: There were 38 patients of SLE. Antinuclear antibody (ANA) was positive in all 38 (100 %), Anti-dsDNA seen in 18 (47.4%). Active urinary sediment & proteinuria was seen in 25 (65.8%) patients and proteinuria in 13 (34.2%) patients. Histopathological patterns were of glomerular involvement, ISN Class II in 2 (5.3%), Class III in 2 (5.3%), class IV in 20 (52.5%), Class V in 6 (15.8%) and mixed IV-V in 8 (21.1%).Conclusions: The diffuse proliferative lupus nephritis (ISN Class IV) was the most common pattern of lupus nephritis encountered in our study followed by mixed pattern (ISN Class IV & V) and membranous lupus nephritis (ISN class IV). Journal of Patan Academy of Health Sciences. 2016 Dec;3(2):10-14

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Pediatric onset lupus nephritis in western India—is it different from the rest of the country?

Lupus ◽

10.1177/09612033211045069 ◽

2021 ◽

pp. 096120332110450

Author(s):

Aliza Mittal ◽

Harshita Bamnawat ◽

Aasma Nalwa ◽

Vikarn Vishwajeet ◽

Prawin Kumar ◽

...

Keyword(s):

Renal Failure ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Care Center ◽

Renal Involvement ◽

Tertiary Care ◽

Neurological Involvement ◽

Western India ◽

Pediatric Systemic Lupus Erythematosus

Aim To determine the clinicopathological characteristics and outcomes of children diagnosed with lupus nephritis in a tertiary hospital in western Rajasthan and compare it with the data available from other parts of India. Material and methods: A retrospective review of children presenting to a tertiary care center in western Rajasthan, India, with a diagnosis of pediatric Systemic Lupus Erythematosus (p SLE), between July 2017 and July 2020 was done. Comparisons of pediatric lupus in western India to other parts of country were done. Results 19 children with SLE with Renal involvement were enrolled and followed up. The median age at presentation was 15 years (IQR-16–9.5) (73% females). 8/19 (42%) children presented with AKI, of which 62% children presented as rapidly progressive renal failure. Six (37.5%) patients required dialysis at presentation. 84.21% of children were evaluated with renal biopsy, 16 biopsies were done in 19 children, among which class II, III, and IV lupus nephritis were reported in 21%,42%, and 35% respectively(4 crescentic). Antiphospholipid antibodies were positive in 8/15(53%), children which is much higher than a reported incidence of 30% in other Indian studies. Ten patients (52%) had neurological involvement, with seizures being the most common form of presentation (60%). Seven patients (36%) developed hepatitis. We noted many uncommon presentations in the small group like Autoimmune Pancreatitis, Mononeuritis multiplex, and peripheral digital gangrene. Cyclophosphamide was used in 10 out of 19 patients for inducing remission with class 3 and 4 nephritis and MMF in 8 children. 55% patients attained remission (after completing induction), of which 4 relapsed during the follow up. Four patients were lost to follow-up. A total of 27% patients died and 10% patients developed end stage renal failure. It was seen that those who died had more cardiac and neurological involvement at presentation, higher grade of proteinuria, lower GFR, and need for dialysis at admission. Conclusion: We found a more severe form of clinical manifestation in pediatric SLE patients at the time of the first presentation in the form of severe renal and extrarenal manifestation compared to other parts of the country.

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Time to Recovery From Proteinuria and Its Related Factors in Patients With Lupus Nephritis

ACTA MEDICA IRANICA ◽

10.18502/acta.v59i9.7555 ◽

2021 ◽

Author(s):

Mir Amir Aghdashi ◽

Khadije Makhdomi ◽

Arash Rashidi

Keyword(s):

Lupus Nephritis ◽

Lupus Erythematosus ◽

Recovery Time ◽

Renal Involvement ◽

Severe Form ◽

University Hospital ◽

Systemic Lupus ◽

Related Factors ◽

The Mean ◽

And Gender

Lupus nephritis (LN) is a severe form of systemic lupus erythematosus (SLE) with renal involvement. It affects the kidneys in about 50% of SLE patients. The aim of this study was to assess the evaluation of proteinuria recovery time and its related factors associated with lupus nephritis patients in Urmia-Northwest of Iran. A retrospective cohort study was carried out, in which medical records of 80 patients with systemic lupus nephritis referred to Imam Khomeini university hospital were reviewed. According to these records, the biopsy-proven renal disease has been progressed from September 2009 to September 2013. Proteinuria, less than 0.5 g/24h, was defined as proteinuria recovery. The time elapsed from the diagnosis of proteinuria to its recovery is considered as the duration of proteinuria recovery (month). The findings were analyzed by STATA11 statistical software. The mean age at diagnosis of lupus nephritis was 26.50±8.10 years (14-51 years). The mean creatinine level at the start of treatment was 1.20±0.61 mg/dl (0.5-2.80). Proteinuria recovery time was four months for 25% of patients, six months for 50% of patients (median time), and 12 months for 75% of them. The higher class of LN had a trend toward 31 % lower risk of proteinuria recovery (HR: 0.73, 95% CI 0.56-0.96; P=0.02), the expected risk is 1.94 times greater in women as compared with men (HR: 1.94, 95% CI 1.1-3.48; P=0.02). The patients in this study population respond to treatment in less time, and in comparison with other studies, their proteinuria recovers earlier. Class of lupus nephritis (negative) and gender (positive) were predictive factors of proteinuria recovery among LN patients.

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Simultaneous presentation of systemic lupus erythematosus and lupus nephritis in mother and son

Lupus ◽

10.1177/0961203311409274 ◽

2011 ◽

Vol 20 (14) ◽

pp. 1541-1546 ◽

Cited By ~ 1

Author(s):

F Lin ◽

C Zhang ◽

D Zhang ◽

X Wu ◽

C Zhu ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Monozygotic Twins ◽

Simultaneous Presentation ◽

Class Iii ◽

Systemic Lupus ◽

Cutaneous Lesions ◽

Complex Interactions

The pathogenesis of systemic lupus erythematosus (SLE) has been attributed to complex interactions between genetic, hormonal and environmental factors. The influence of a genetic predisposition to SLE is supported by family aggregation and a high concordance rate in monozygotic twins. Here we present a rare case of simultaneous presentation of SLE and lupus nephritis in a mother and son. Both patients had nephrotic-range proteinuria, and the renal pathological classifications of the son and his mother were Class IV-G (A) and Class III (A/C), respectively, according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification of lupus nephritis. Apart from the renal involvement, both patients had leucopenia and anemia, and the mother also had typical cutaneous lesions and secondary Sjögren’s syndrome. This case supports the genetic role in the etiology of SLE, and displayed different clinical presentations and disease severity in familial SLE patients of different gender and age.

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