Clinical and laboratory findings versus results of renal biopsy: Evaluation the diagnostic value in patients with lupus nephritis

Abstract INTRODUCTION: Lupus nephritis (LN) is a major complication of systemic lupus erythematosus (SLE). Renal involvement is a major determinant of the prognosis of SLE. The histological classification of LN is a key factor in determining the renal survival of patients with LN. Prompt recognition and treatment of renal disease are important, as early response to therapy is correlated with better outcome and renal biopsy plays an important role in achieving this. OBJECTIVES: The objective of this study was to correlate the clinical and laboratory findings with histopathological classes of LN as per the 2003 International Society of Nephrology-Renal Pathology Society (ISN/RPS) classification system. PATIENTS AND METHODS: Fifty-six patients with SLE, undergoing a renal biopsy for renal dysfunction were studied. The comparison of data from multiple groups was made by Pearson’s Chi-square test and between two groups by independent samples t-test. The values of P < 0.05 were considered statistically significant. RESULTS: Of the 56 cases studied, 51 (91.1%) were females. The most common presenting symptoms were edema, arthralgia, and hypertension. Class IV (55.4%) was the most common class. Thirty-nine (69.6%) cases showed full house immunostaining. Hypertension, hematuria, proteinuria, and tu bulo-interstitial disease showed a significant correlation (P < 0.05) with ISN/RPS classification, 2003. CONCLUSION: Assessment and management of patients with suspected LN are greatly facilitated through information obtained by renal biopsy. Since renal morphology may predict long-term prognosis, and no clinical or laboratory feature uniformly predicts prognosis, it is important to study the constellation of features in LN for better patient management.

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Clinicopathological Correlation in Asian Patients with Biopsy-Proven Lupus Nephritis

International Journal of Nephrology ◽

10.1155/2015/857316 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Bancha Satirapoj ◽

Pamila Tasanavipas ◽

Ouppatham Supasyndh

Keyword(s):

Renal Function ◽

Lupus Nephritis ◽

Renal Biopsy ◽

Impaired Renal Function ◽

Activity Index ◽

Clinicopathological Correlation ◽

Laboratory Findings ◽

Male Ratio ◽

Asian Patients ◽

Chronicity Index

A total of 244 patients with lupus nephritis (219 women (89.8%) with a female to male ratio of 9 : 1) were included in the study. Clinical and laboratory findings at renal biopsy are clinically valuable in identifying different renal classifications of lupus pathology, activity, and chronicity index. Patients with class IVG had significantly higher proportions of microscopic hematuria, proteinuria, hypertension, impaired renal function, anemia, hypoalbuminuria, and positive anti-DNA antibody. All of these findings correlated well with high activity index and chronicity index of lupus pathology. Considering these correlations may help to determine the clinicopathologic status of lupus patients.

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Interpretation of Clinical and Laboratory Findings of Patients with Lupus Nephritis According to the Results of Biopsy

Zahedan Journal of Research in Medical Sciences ◽

10.5812/zjrms.86588 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Parviz Soufivand ◽

Abdolrahman Rostamian ◽

Mohammad Reza Abbasi ◽

Fatemeh Shahbazi

Keyword(s):

Lupus Nephritis ◽

Clinical Manifestations ◽

Study Groups ◽

Diagnostic Value ◽

Clinical Findings ◽

Laboratory Findings ◽

Exact Test ◽

Limb Edema ◽

Severity Of The Disease ◽

Compare Study

Background: There are controversies regarding the diagnosis of lupus nephritis. Also, its clinical manifestations and severity are different from one patient to another. Objectives: The current study aimed to interpret clinical and laboratory features of lupus nephritis according to the results of the biopsy. Methods: Following a retrospective design, 30 patients with lupus, who were candidates for renal biopsy and undergoing kidney biopsy, were studied. Clinical findings (blood pressure and limb edema) and laboratory findings (Cr, ESR, CRP, BUN, C3, C4, CH50, Anti-ds DNA, and hematuria) were gathered. Finally, the diagnostic value of clinical and laboratory findings was interpreted according to the biopsies and the staging of samples in the pathology. Data were analyzed using SPSS. Quantitative variables are displayed using mean and quartiles. Fisher’s exact test was used to compare study groups. Also, independent samples t-test and Levene’s test were used to evaluate variances of quantitative variables. Results: Of 30 cases, 5 had a biopsy of 3 and FSGN. Also, 8 cases were on stages 3 and 4, 9 had a stage of 4 biopsy, and 8 cases were on stage 4 - 5, 5, and 5 - 6. The association between age, Limp edema, ESR, and biopsy was statistically significant (P < 0.05). Conclusions: This study demonstrated the usefulness of clinical and laboratory findings to determine the severity of the disease in the shortest time, mainly due to its easy, non-invasive access and early preparation of the results, which will facilitate the initiation of treatment.

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CLINICO-PATHOLOGICAL CHARACTERISTICS OF LUPUS NEPHRITIS IN EASTERN ZONE OF INDIA: A SINGLE TERTIARY CENTER EXPERIENCE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2016.v9i5.12558 ◽

2016 ◽

Vol 9 (5) ◽

pp. 102 ◽

Cited By ~ 1

Author(s):

Smaraka Ranjan Panda ◽

Chittaranjan Kar ◽

Prasant Kumar Sahu ◽

Sashibhusan Rout ◽

Bishwaranjan Mohanty ◽

...

Keyword(s):

Lupus Nephritis ◽

Renal Biopsy ◽

Lupus Erythematosus ◽

Prognostic Information ◽

Urine Sediment ◽

Laboratory Findings ◽

Medical College ◽

Tertiary Center ◽

Renal Biopsies ◽

Class Iv

ABSTRACTObjective: Lupus nephritis (LN) is the most common and serious manifestation of systemic lupus erythematosus (SLE) and an important cause ofmorbidity and mortality. Although diagnosis of LN is straight forward in a patient with SLE and proteinuria, and active urine sediment and perhapsrenal insufficiency, still renal biopsies are required at diagnosis to enable classification of nephritis severity, to provide prognostic information, and toguide treatment. Hence, the objective of this study is to determine the frequency of distribution of different classes of LN based on renal biopsy reportsand to correlate it with various laboratory findings.Methods: Retrospective study was done in all patients with LN who had at least one representative renal biopsy and evaluated in NephrologyDepartment of SCB Medical College, Cuttack, in 6-month duration. Various laboratory values were recorded and correlated with histopathologicallupus classifications.Results: Out of 35 patients enrolled, 33 (94.28%) were females and 2 (5.71%) were males. Mean age was 27.53±12.26 years. Majority of cases belongto Class IV followed by Class V. Patients of Class IV LN have a significantly low hemoglobin level. Similarly, serum urea and creatinine are higher inGroup IV than other groups, and serum creatinine was found to be significant. 24 hrs urinary protein excretion has a significant correlation with theclasses of LN.Conclusion: This study suggests some meaningful correlation between laboratory findings and histopathological lupus classification. This study alsosuggests that renal biopsies are still beneficial for better evaluation of renal status and determination of LN classes.Keywords: Clinico-pathological correlation, Lupus nephritis, Biopsy.

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Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

Nuklearmedizin ◽

10.1055/s-0038-1629824 ◽

1996 ◽

Vol 35 (04) ◽

pp. 116-121 ◽

Cited By ~ 4

Author(s):

G. E Fueger ◽

M. Vejda ◽

R. M. Aigner

Keyword(s):

Bone Scintigraphy ◽

Antibiotic Treatment ◽

Diagnostic Value ◽

Clinical Findings ◽

Laboratory Findings ◽

Radiographic Findings ◽

Serum Parameters ◽

Wbc Count ◽

Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

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SAT0211 RENAL INJURY IN SYSTEMIC LUPUS ERYTHEMATOSUS CHARACTERIZED BY THROMBOTIC MICROANGIOPATHY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1198 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1048.1-1048

Author(s):

W. Hu

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Renal Biopsy ◽

Lupus Erythematosus ◽

Thrombotic Microangiopathy ◽

Renal Injury ◽

Renal Outcome ◽

Pathological Examination ◽

Systemic Lupus ◽

Tubulointerstitial Lesions

Background:Classical lupus nephritis (LN) is characterized by glomerular immune complex(IC) deposition with glomerular proliferation, basement membrane destruction and cell infiltration. Non-IC mediated renal injury with thrombotic microangiopathy (TMA) was also reported in patients with systemic lupus erythematosus (SLE-renal TMA), but most studies were reported in patients with both LN and renal TMA.Objectives:In this study, clinical features and outcomes of SLE-renal TMA in absence of obvious IC in SLE patients were analyzed.Methods:Patients with glomerular TMA and/or vascular TMA in the absence of obvious subendothelial or epithelial immune deposits were screened out from 2332 biopsied in SLE patients who underwent first renal biopsy from January 2005 to August 2016. Their clinical, histological features and outcomes were retrospectively analyzed.Results:In 2332 renal biopsies obtained from SLE patients, 257 (11.0%) showed renal TMA, of which 237 showed both renal TMA and LN, and 20 biopsies had only renal TMA (SLE-renal TMA). There were 2 males and 18 females with an average age of (25 ± 10) years. The median course of SLE and LN were 3.0(1.0, 6.0) and 0.8(0.5, 1.9) months. All 20 patients deserved acute kidney injury, of which 11 (55%) needed renal replacement therapy (RRT) and 12 (60%) were nephrotic syndrome. Blood system involvement was found in all cases, including 13 cases (65.0%) with TMA triad (microvascular hemolytic anemia, thrombocytopenia and elevated lactate dehydrogenase).Pathological examination showed that 17 cases (85.0%) had both glomerular TMA and vascular TMA. Immunofluorescence and electron microscopy showed that 8 cases (40%) had no IC deposition in glomerulus and 12 cases (60%) had only IC deposition in mesangium. Acute tubulointerstitial lesions in patients requiring RRT were more serious than those no needing for RRT((43.6±24.9) %vs(21.7±20.1) %,P=0.047). The fusion range of foot process was positively correlated with proteinuria (r2= 0.347,P=0.006).All patients received high-dose methylprednisolone pulse therapy. Four patients received plasma exchange and three patients received gamma globulin, respectively. Eleven patients requiring RRT all stop RRT in a median time of 16.0 (9.0, 30.0) days. During a median follow-up of 58.0 (36.0, 92.3) months, complete remission (CR) was obtained in 15 cases, partial remission in 4 cases and no remission in 1 case. Six cases (30%) relapsed. No case died or progressed to end stage renal disease.Conclusion:Renal injury characterized by TMA is not uncommon in SLE renal biopsy cases. The clinical manifestation is special and the renal injury is serious. The renal outcome is good by intensive immunosuppressive therapy. It should be considered as a unique type of renal injury in SLE.References:[1]Moake JL. Thrombotic microangiopathies. N Engl J Med. 2002. 347(8): 589-600.[2]Anders HJ, Weening JJ. Kidney disease in lupus is not always ‘lupus nephritis’. Arthritis Res Ther. 2013. 15(2): 108.[3]Song D, Wu LH, Wang FM, et al. The spectrum of renal thrombotic microangiopathy in lupus nephritis. Arthritis Res Ther. 2013. 15(1): R12.[4]Hu WX, Liu ZZ, Chen HP, Zhang HT, Li LS, Liu ZH. Clinical characteristics and prognosis of diffuse proliferative lupus nephritis with thrombotic microangiopathy. Lupus. 2010. 19(14): 1591-8.[5]Tomov S, Lazarchick J, Self SE, Bruner ET, Budisavljevic MN. Kidney-limited thrombotic microangiopathy in patients with SLE treated with romiplostim. Lupus. 2013. 22(5): 504-9.[6]Li C, Yap D, Chan G, et al. Clinical Outcomes and Clinico-pathological Correlations in Lupus Nephritis with Kidney Biopsy Showing Thrombotic Microangiopathy. J Rheumatol. 2019 .[7]Chen MH, Chen MH, Chen WS, et al. Thrombotic microangiopathy in systemic lupus erythematosus: a cohort study in North Taiwan. Rheumatology (Oxford). 2011. 50(4): 768-75.[8]Park MH, AUID- Oho, Caselman N, Ulmer S, Weitz IC, AUID- Oho. Complement-mediated thrombotic microangiopathy associated with lupus nephritis. Blood Adv. 2018. 2(16): 2090-2094.Disclosure of Interests:None declared

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The Continuing Need for Electron Microscopy in Examination of Medical Renal Biopsies: Examples in Practice

Glomerular Diseases ◽

10.1159/000516831 ◽

2021 ◽

pp. 1-15

Author(s):

Michifumi Yamashita ◽

Mercury Y. Lin ◽

Jean Hou ◽

Kevin Y.M. Ren ◽

Mark Haas

Keyword(s):

Electron Microscopy ◽

Renal Biopsy ◽

Renal Allograft ◽

Comprehensive Evaluation ◽

Diagnostic Value ◽

Ultrastructural Studies ◽

The Past ◽

Biopsy Diagnosis ◽

Renal Biopsies ◽

Clinical Consequences

Background: For the better part of the past 6 decades, transmission electron microscopy (EM), together with routine light microscopy and immunofluorescence and/or immunohistochemistry (IHC), has been an essential component of the diagnostic workup of medical renal biopsies, particularly native renal biopsies, with increasing frequency in renal allograft biopsies as well. Studies performed prior to the year 2000 have indeed shown that a substantial fraction of renal biopsies cannot be accurately diagnosed without EM. Still, EM remains costly and labor-intensive, and with increasing pressure to reduce healthcare costs, some centers are de-emphasizing diagnostic EM. This trend has been coupled with advances in IHC and other methods in renal biopsy diagnosis over the past 2–3 decades. Summary: Nonetheless, it has been our experience that the diagnostic value of EM in the comprehensive evaluation of renal biopsies remains similar to what it was 20–30 years ago. In this review, we provide several key examples from our practice where EM was essential in making the correct renal biopsy diagnosis, ranging from relatively common glomerular lesions to rare diseases. Key Messages: EM remains an important component of the diagnostic evaluation of medical renal biopsies. Failure to perform EM in certain cases will result in an incorrect diagnosis, with possible clinical consequences. We strongly recommend that tissue for EM be taken and stored in an appropriate fixative and ultrastructural studies be performed for all native renal biopsies, as well as appropriate renal allograft biopsies as recommended by the Banff consortium.

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Clinical and immunological characteristics of 150 systemic lupus erythematosus patients in Jamaica: a comparative analysis

Lupus ◽

10.1177/0961203317707828 ◽

2017 ◽

Vol 26 (13) ◽

pp. 1448-1456 ◽

Cited By ~ 4

Author(s):

K C Maloney ◽

T S Ferguson ◽

H D Stewart ◽

A A Myers ◽

K De Ceulaer

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Disease Activity ◽

Renal Biopsy ◽

Diagnostic Criteria ◽

Lupus Erythematosus ◽

Antinuclear Antibodies ◽

Damage Index ◽

Systemic Lupus ◽

Dsdna Antibodies

Background Epidemiological studies in systemic lupus erythematosus have been reported in the literature in many countries and ethnic groups. Although systemic lupus erythematosus in Jamaica has been described in the past, there has not been a detailed evaluation of systemic lupus erythematosus patients in urban Jamaica, a largely Afro-Caribbean population. The goal of this study was to describe the clinical features, particularly disease activity, damage index and immunological features, of 150 systemic lupus erythematosus subjects. Methods 150 adult patients (≥18 years) followed in rheumatology clinic at a tertiary rheumatology hospital centre (one of two of the major public referral centres in Jamaica) and the private rheumatology offices in urban Jamaica who fulfilled Systemic Lupus International Collaborating Clinics (SLICC) criteria were included. Data were collected by detailed clinical interview and examination and laboratory investigations. Hence demographics, SLICC criteria, immunological profile, systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) and SLICC/American College of Rheumatology (ACR) damage index (SDI) were documented. Results Of the 150 patients, 145 (96.7%) were female and five (3.3%) were male. The mean age at systemic lupus erythematosus onset was 33.2 ± 10.9. Mean disease duration was 11.3 ± 8.6 years. The most prevalent clinical SLICC criteria were musculoskeletal, with 141 (94%) of subjects experiencing arthralgia/arthritis, followed by mucocutaneous manifestations of alopecia 103 (68.7%) and malar rash 46 (30.7%), discoid rash 45 (30%) and photosensitivity 40 (26.7%). Lupus nephritis (biopsy proven) occurred in 42 (28%) subjects and 25 (16.7%) met SLICC diagnostic criteria with only positive antinuclear antibodies/dsDNA antibodies and lupus nephritis on renal biopsy. The most common laboratory SLICC criteria were positive antinuclear antibodies 136 (90.7%) followed by anti-dsDNA antibodies 95 (63.3%) and low complement (C3) levels 38 (25.3%). Twenty-seven (18%) met SLICC diagnostic criteria with only positive antinuclear antibodies/anti-dsDNA antibodies and lupus nephritis on renal biopsy. Mean SLEDAI score was 6.9 ± 5.1 with a range of 0–32. Organ damage occurred in 129 (86%) patients; mean SDI was 2.4 ± 1.8, with a range of 0–9. Conclusion These results are similar to the clinical manifestations reported in other Afro-Caribbean populations; however, distinct differences exist with respect to organ involvement and damage, particularly with respect to renal involvement, which appears to be reduced in our participants.

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Mesangial lupus nephritis with associated nephrotic syndrome.

Journal of the American Society of Nephrology ◽

10.1681/asn.v871199 ◽

1997 ◽

Vol 8 (7) ◽

pp. 1199-1204

Author(s):

N Stankeviciute ◽

W Jao ◽

A Bakir ◽

J P Lash

Keyword(s):

Nephrotic Syndrome ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

World Health ◽

Clinical Tool ◽

Laboratory Findings ◽

Glomerular Lesion ◽

Health Organization ◽

Lupus Glomerulonephritis ◽

Nephrotic Range Proteinuria

Patients with mesangial proliferative lupus glomerulonephritis (World Health Organization class II) are generally believed to have only mild to moderate proteinuria and normal renal function. However, there have been several reports of patients with mesangial lupus with nephrotic-range proteinuria. In this report, we present two additional cases and review the literature. Of seven reported cases, persistent nephrotic syndrome was observed in four, morphologic transformation occurred in three, and all but one presented with varying degrees of azotemia. These cases reinforce the concept that in systemic lupus erythematosus, laboratory findings may not correlate well with the underlying glomerular lesion, and therefore, the renal biopsy is an essential clinical tool in the approach to lupus nephritis.

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Frequency of Histopathological patterns of Lupus Nephritis according to classification by WHO among Pakistani patients

10.53350/pjmhs211592343 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2343-2344

Author(s):

Aijaz Z. Khan Chachar ◽

Miqdad Haider ◽

Naveed A. Lashari ◽

M. Mueed Yasin ◽

Hafiz B. A. Kalhoro ◽

...

Keyword(s):

Lupus Nephritis ◽

Renal Biopsy ◽

Lupus Erythematosus ◽

Who Classification ◽

Correct Diagnosis ◽

Class Ii ◽

Class Iii ◽

Childbearing Age ◽

Systemic Lupus ◽

Cross Sectional

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder, multisystemic in nature more common in females of childbearing age. There are certain risk factors which predispose to this disease. It affects various organs, kidney is among them. Almost 60% patients having SLE ultimately leads to kidney dysfunction at some stage of the life. Aim: To find out pattern of histopathological findings of lupus nephritis as per WHO classification on kidney biopsy in Pakistan. Methodology: This cross-sectional study was completed in department of Medicine, Fatima Memorial Hospital, Lahore, from March 2016 to May, 2018. Total sample size was 165 patients. Only patients who fulfilled the 2012 SLICC (Systemic Lupus International Collaborating Clinics) criteria were included in the study. SPSS version 25.0 was used data analysis. Results: Age of the patients was between 31-50 years i.e. 114(69.09%), mean and SD was 43.96±4.84 years, females were more commonly affected by calculating 99(59.70%). Patterns of lupus nephritis as per WHO classification and renal biopsy were noted which shows 18(10.91%) had Class I, 53(32.12%) Class II, 43(26.07%) Class III, 35(21.20%) Class IV, 10(6.06%) Class V and 6(3.64%) had Class VI. Conclusion: Class II and Class III Lupus Nephritis are the most common modalities found in patients of SLE. Every patient with Lupus Nephritis should undergo a Renal Biopsy for correct diagnosis of the class of this disease and further management accordingly. Keywords: Lupus Nephritis, SLE, renal biopsy

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