Childhood Systemic Lupus Erythematosus: A Tertiary Care Centre Experience

Introduction: Systemic lupus erythematosus (SLE) is a chronic immunologic disorder with multisystem manifestations. Even more awareness is required to diagnose the disease at younger age. Objective of this study was to explore clinico-laboratory manifestations and management of SLE in children at Tribhuvan University Teaching Hospital (TUTH).Materials and Methods: The study was retrospective hospital based study conducted from 15th July, 2008 to 14th July, 2014. Medical charts of all children and adolescent (6- 16years of age) with SLE admitted at TUTH were reviewed for analysis of data.Results: The total number of patients was 33, with 28(84.8%) girls and 5 (15.2%) boys. The mean age of diagnosis was 12.12 (SD 1.89). Facial puffiness (27.3%) and arthralgia (24.2%) were the commonest presentations at disease onset. The most frequent clinical features during the entire course of illness were edema (78.9%), anemia (69.7%) and fever (66.7%). Twenty three (69.6%) patients underwent renal biopsy in which class IV was the commonest lupus nephritis. The commonly used drugs after prednisolone were intravenous cyclophosphamide, intravenouse methylprednisolone and mycophenolate mofetil. Total 17 (51.5%) patients went into remission. Two patients died due to active lupus and four due to sepsis.Conclusion: Lupus nephritis was the commonest feature at disease onset, at the time of diagnosis and throughout the disease course among Nepalese children with SLE. The most frequently used medications were prednisolone and iv cyclophosphamide. Infection and active lupus were the leading causes of complications and death.J Nepal Paediatr Soc 2015;35(2):111-116

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Characteristics of lupus and lupus nephritis at a tertiary care center in Lebanon

Lupus ◽

10.1177/0961203319877459 ◽

2019 ◽

Vol 28 (13) ◽

pp. 1598-1603 ◽

Cited By ~ 1

Author(s):

S H Koubar ◽

J Kort ◽

S Kawtharani ◽

M Chaaya ◽

M Makki ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Kidney Disease ◽

Complete Remission ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Partial Remission ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Systemic Lupus

Introduction Systemic lupus erythematosus affects 4.8–78.5 people per 100,000 worldwide, 90% of whom are females. Geography and ethnicity have been shown to significantly affect the prevalence and natural history of the disease. Lupus nephritis affects around half of patients with systemic lupus erythematosus. Data about systemic lupus erythematosus and lupus nephritis in the Middle East are still scarce. In this study, we aimed to describe the characteristics of systemic lupus erythematosus and lupus nephritis at a tertiary care center in Lebanon. Methods This is a retrospective chart review of all biopsy-proven lupus nephritis patients admitted to the American University of Beirut medical center between January 2000 and December 2018. Patients above 12 years of age who had any International Society of Nephrology/Renal Pathology Society (ISN/RPS) class of lupus nephritis on their renal biopsy were included in the study. Results The study included 55 patients with lupus nephritis. Upon presentation of systemic lupus erythematosus, the most common clinical feature was arthritis, seen in 83% of patients, followed by anemia (82%) and malar rash (48%). In total 93% had positive ANA, 89% had positive anti-dsDNA and 98% of patients had proteinuria. The most common ISN/RPS class of lupus nephritis in our series was IV (49%). At the time of the biopsy 15% of patients underwent dialysis. At 6 months, 11/27 had complete remission, 6/27 had partial remission and 10/27 had no remission. At 1 year, 8/23 had complete remission, 4/23 had partial remission and 11/23 had no remission. During the study period, 15 out of 35 patients available for analysis had chronic kidney disease (CKD) and six out of 34 patients developed end-stage kidney disease requiring renal replacement therapy. In comparison to other series in the region, our series had more males affected, higher creatinine at the time of biopsy and greater degree of proteinuria. Conclusion Our study provided insight on the demographics, characteristics, and outcomes of lupus nephritis in Lebanon. Interestingly, male gender was present in a quarter of patients. This warrants further investigation and confirmation. We are hoping to expand this experience into a national prospective registry to further characterize this entity in our region.

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PREVALENCE OF PULMONARY HYPERTENSION IN UNSELECTED PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN AN ACADEMIC TERTIARY CARE CENTRE

CHEST Journal ◽

10.1378/chest.136.4_meetingabstracts.55s ◽

2009 ◽

Vol 136 (4) ◽

pp. 55S

Author(s):

Abdul G. Gari ◽

Bryan Dias ◽

Janet Pope ◽

Sanjay Mehta

Keyword(s):

Systemic Lupus Erythematosus ◽

Pulmonary Hypertension ◽

Lupus Erythematosus ◽

Tertiary Care ◽

Care Centre ◽

Systemic Lupus ◽

Tertiary Care Centre

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The association between serum prolactin levels and interleukin-6 and systemic lupus erythematosus activity

Reumatismo ◽

10.4081/reumatismo.2018.1075 ◽

2018 ◽

Vol 70 (4) ◽

pp. 241-250 ◽

Cited By ~ 4

Author(s):

W.A. Wan Asyraf ◽

M.S. Mohd Shahrir ◽

W. Asrul ◽

A.W. Norasyikin ◽

O. Hanita ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Disease Activity ◽

Lupus Erythematosus ◽

Prolactin Level ◽

Serum Prolactin ◽

Systemic Lupus ◽

Serum Prolactin Level ◽

Active Lupus Nephritis ◽

Active Lupus

Based on the recent evidence of association between hyperprolactinemia and systemic lupus erythematosus disease activity (SLEDAI), a study was conducted to analyze the association of hyperprolactinemia with lupus nephritis disease activity. In this cross-sectional study, the analysis was conducted on SLE patients who visited the University Kebangsaan Malaysia Medical Centre (UKMMC) Nephrology Clinic from August 2015 till February 2016. The disease activity was measured using the SLEDAI score, with more than 4 indicating active lupus nephritis. Basal resting prolactin level was analyzed in 43 patients with lupus nephritis, in 27.9% of them had raised serum prolactin. The median of serum prolactin level at 0 minutes was 19.91 ng/mL (IQR: 15.95-22.65 ng/ mL) for active lupus nephritis, which was significantly higher compared to the median of serum prolactin level of 14.34 ng/mL (IQR: 11.09-18.70 ng/mL) for patients in remission (p=0.014). The serum prolactin level positively correlated with SLEDAI (rhos: 0.449, p=0.003) and the UPCI level in lupus nephritis patients (rhos: 0.241, p=0.032). The results were reproduced when the serum prolactin was repeated after 30 minutes. However, the serum prolactin levels at 0 minutes were higher than those taken after 30 minutes (p=0.001). An assessment of serum IL-6 levels found that the active lupus nephritis patients had a higher median level of 65.91 pg/ mL (IQR: 21.96-146.14 pg/mL) compared to the in-remission level of 15.84 pg/mL (IQR: 8.38-92.84 pg/mL), (p=0.039). Further correlation analysis revealed that there was no statistical correlation between the interleukin (IL)-6 levels with serum prolactin, SLEDAI and other lupus nephritis parameters. An ROC curve analysis of serum prolactin at 0 minutes and serum prolactin after 30 minutes and IL-6 levels for prediction of SLE disease activity provided the cutoff value of serum prolactin at 0 minutes, which was 14.63 ng/mL with a sensitivity of 91.7% and specificity of 58.1% and AUC of 0.74 (p=0.015). This study concurred with the previous findings that stated that hyperprolactinemia is prevalent in SLE patients and correlated with clinical disease activity and UPCI level. The baseline of the fasting serum prolactin level was found to be a sensitive biomarker for the evaluation of lupus nephritis disease activity.

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