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

2011 ◽  
Vol 39 (1) ◽  
pp. 79-85 ◽  
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.

scholarly journals Histopathological findings of renal biopsy in systemic lupus erythematosus

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

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

Lupus ◽  
2011 ◽  
Vol 20 (14) ◽  
pp. 1541-1546 ◽  
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.

scholarly journals An uncommon cause of diffuse alveolar hemorrhage in a young male

2019 ◽  
Vol 89 (2) ◽  
Author(s):  
Anshul Mittal ◽  
Jagdish Chander Suri ◽  
Shibdas Chakrabarti ◽  
Pranav Ish
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Young Male ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Systemic Lupus ◽  
Threatening Condition ◽  
Life Threatening

It is uncommon for Systemic lupus erythematosus (SLE) to present with diffuse alveolar hemorrhage (DAH) as the initial presentation. To diagnose this in a young male with no renal involvement is further uncommon. We report a case of a 16-year-old boy, who presented with hemoptysis and was eventually diagnosed as DAH with underlying SLE. Treatment with steroids and immunosuppressant helped in rapid recovery from this potentially life-threatening condition. This case highlights the need of defining diagnostic criteria for SLE in patients presenting as DAH and formulating guidelines for treatment of the same, especially in absence of co-existing lupus nephritis.

scholarly journals Presentation of Childhood Systemic Lupus Erythematosus in a Tertiary Care Hospital

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

scholarly journals Comparative analysis of neutrophil gelatinase-associated lipocalin and other laboratory markers for lupus nephritis: a cross-sectional investigation

2016 ◽  
Vol 54 (2) ◽  
pp. 240-245 ◽  
Author(s):  
Sonia L La’ulu ◽  
Brenda B Suh-Lailam ◽  
K Wayne Davis ◽  
Joely A Straseski ◽  
Anne E Tebo
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Immunofluorescence Assay ◽  
Igg Antibodies ◽  
Systemic Lupus ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Double Stranded Dna ◽  
Neutrophil Gelatinase

Background Lupus nephritis is one of the most serious complications of systemic lupus erythematosus. This study evaluates the prevalence and correlation between neutrophil gelatinase-associated lipocalin and other biomarkers associated with renal involvement in systemic lupus erythematosus. Methods Paired serum and urine specimens from 50 suspected systemic lupus erythematosus patients, characterized by antinuclear antibodies detected by indirect immunofluorescence assay and varying positive concentrations of anti-double stranded DNA antibodies by Crithidia luciliae immunofluorescence assay, were investigated. Of these 50 patients, 18 were identified with renal involvement based upon laboratory serology. Patients and healthy control serum samples ( n = 50) were also evaluated for high avidity double stranded DNA IgG antibodies, anti-C1q IgG antibodies, and serum creatinine. The prevalence and relationship between biomarkers were evaluated using statistical methods. Results Serum and urine neutrophil gelatinase-associated lipocalin concentrations were significantly elevated in patients compared to controls, with a prevalence of 24% and 36%, respectively. These concentrations were also more markedly increased in systemic lupus erythematosus patients with renal involvement than those without. Spearman’s correlations between neutrophil gelatinase-associated lipocalin and other biomarkers tested ranged from 0.06 to 0.66 in all patients. Combined concordance as determined by Cronbach alpha coefficient between biomarkers was reduced from 0.71 to 0.58 (serum) and 0.62 (urine) when neutrophil gelatinase-associated lipocalin was removed. Conclusions Neutrophil gelatinase-associated lipocalin concentrations are elevated and demonstrate variable associated with other laboratory markers for renal involvement in systemic lupus erythematosus. Prospective longitudinal studies are needed to determine the optimal biomarker combinations for use in routine management of systemic lupus erythematosus patients at-risk for lupus nephritis.

scholarly journals Validity test of anti-c1q serum as diagnostic marker for lupus nephritis

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
M Enrica ◽  
A Tjandrawati ◽  
S Rachmayati ◽  
Laniyati Hamijoyo
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Predictive Value ◽  
Renal Involvement ◽  
Enzyme Linked Immunosorbent Assay ◽  
Specific Marker ◽  
Systemic Lupus ◽  
Urine Protein ◽  
American College Of Rheumatology

Background: Lupus nephritis is defined as renal involvement in systemic lupus erythematosus (SLE) patients and the most important cause of morbidity and mortality. The diagnostic criteria that used to diagnose lupus nephritis are 1997 American Collegeof Rheumatology is 24 hours urine protein ≥500 mg and/or cellular cast, but significant renal damage can occur without proteinuria or cellular cast. Anti-C1q is an autoantibody that is produced by a chronic alteration of C1q collagen domain. Anti-C1q is a new specific marker for renal marker.Objective: To determine the validity of anti-C1q serum by using 1997 American College of Rheumatology criteria as a gold standard. Methods: This is a cross sectional study, conducted in October to December 2014 at Hasan Sadikin Hospital Bandung. The subjects had systemic lupus erythematosus with and without renal involvement, based on 1997 American College of Rheumatology criteria for SLE.Results: There were 65 subjects included in this study, 64 subjects were female and 1 subject was male. The age average was 32 (SD 11.7) years old. As many as 66.2% subjects had been diagnosed with lupus erythematosus systemic at least 3 years. Twenty four hours urine protein was measured using spectrophotometry, urine sediment was examinedfor cellular cast, and anti-C1q serum was measured using micro enzyme linked immunosorbent assay. Based on American College of Rheumatology criteria, 34 subjects were classified as lupus nephritis group while 31 subjects were classified as non-lupus nephritis group. The area under the curve of anti-C1q was 0.610. The cut-off value used in this study was 10.43 U/ml. The sensitivity, specificity, positive predictive value,negative predictive value and accuracy of anti-C1q assay were 41.18%, 77.42%, 66.67%, 54.55% and 58.46% respectively.Conclusion: Anti-C1q assay, based on this study, hasa low sensitivity and medium specificity to detect lupusnephritis

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 Plasma cytokines as potential biomarkers of kidney damage in patients with systemic lupus erythematosus

Lupus ◽  
2018 ◽  
Vol 28 (1) ◽  
pp. 34-43 ◽  
Author(s):  
L. Pacheco-Lugo ◽  
J. Sáenz-García ◽  
E Navarro Quiroz ◽  
H. González Torres ◽  
L. Fang ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Characteristic Curve ◽  
Renal Involvement ◽  
Interleukin 17 ◽  
Systemic Lupus ◽  
Cytokines And Chemokines ◽  
Xmap Technology

Background Systemic lupus erythematosus is a heterogeneous chronic inflammatory autoimmune disorder characterized by an exacerbated expression of cytokines and chemokines in different tissues and organs. Renal involvement is a significant contributor to the morbidity and mortality of systemic lupus erythematosus, and its diagnosis is based on renal biopsy, an invasive procedure with a high risk of complications. Therefore, the development of alternative, non-invasive diagnostic tests for kidney disease in patients with systemic lupus erythematosus is a priority. Aim To evaluate the plasma levels of a panel of cytokines and chemokines using multiplex xMAP technology in a cohort of Colombian patients with active and inactive systemic lupus erythematosus, and to evaluate their potential as biomarkers of renal involvement. Results Plasma from 40 systemic lupus erythematosus non-nephritis patients and 80 lupus nephritis patients with different levels of renal involvement were analyzed for 39 cytokines using Luminex xMAP technology. Lupus nephritis patients had significantly increased plasma eotaxin, TNF-α, interleukin-17-α, interleukin-10, and interleukin-15 as compared to the systemic lupus erythematosus non-nephritis group. Macrophage-derived chemokine, growth regulated oncogene alpha, and epidermal growth factor were significantly elevated in systemic lupus erythematosus non-nephritis patients when compared to lupus nephritis individuals. Plasma eotaxin levels allowed a discrimination between systemic lupus erythematosus non-nephritis and lupus nephritis patients, for which we performed a receiver operating characteristic curve to confirm. We observed a correlation of eotaxin levels with active nephritis (Systemic Lupus Erythematosus Disease Activity Index). Our data indicate that circulating cytokines and chemokines could be considered good predictors of renal involvement in individuals with systemic lupus erythematosus.

scholarly journals Correlation of Circulating Glucocorticoid-Induced TNFR-Related Protein Ligand Levels with Disease Activity in Patients with Systemic Lupus Erythematosus

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Lei Gu ◽  
Lingxiao Xu ◽  
Xiaojun Zhang ◽  
Wenfeng Tan ◽  
Hong Wang ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Inactive Disease ◽  
Healthy Controls ◽  
Related Protein ◽  
Systemic Lupus ◽  
Dsdna Antibody

The aim of this paper is to investigate the correlation of glucocorticoid-induced tumor necrosis factor receptor- (TNFR-) related protein ligand (GITRL) with disease activity and organ involvement in patients with systemic lupus erythematosus (SLE). Serum GITRL levels were measured in 58 patients with SLE and 30 healthy controls matched for age and sex. Patients were assessed for clinical and laboratory variables. Correlations of serum GITRL levels with SLEDAI, laboratory values, and clinical manifestations were assessed. Serum GITRL levels were determined by ELISA. Serum GITRL levels were markedly increased in patients with SLE compared with healthy controls (mean 401.3 ng/mL and 36.59 ng/mL, resp.;P<0.0001). SLE patients with active disease showed higher serum GITRL levels compared to those with inactive disease (mean 403.3 ng/mL and 136.3 ng/mL, resp;P=0.0043) as well as normal controls (36.59 ng/mL;P<0.0001). Serum GITRL levels were positively correlated with SLEDAI, titers of anti-dsDNA antibody, erythrocyte sedimentation rate (ESR), and IgM and negatively correlated with complement3 (C3). Serum GITRL levels were higher in SLE patients with renal involvement and vasculitis compared with patients without the above-mentioned manifestations.

scholarly journals Antiphospholipid Syndrome Nephropathy in Systemic Lupus Erythematosus

2002 ◽  
Vol 13 (1) ◽  
pp. 42-52
Author(s):  
Eric Daugas ◽  
Dominique Nochy ◽  
Du Le Thi Huong ◽  
Pierre Duhaut ◽  
Hélène Beaufils ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Interstitial Fibrosis ◽  
Renal Involvement ◽  
Elevated Serum ◽  
Systemic Lupus ◽  
Elevated Serum Creatinine

ABSTRACT. In the course of the antiphospholipid syndrome (APS), the existence of vaso-occlusive lesions capable of affecting numerous organs is now well established. The renal involvement attributable to primary APS, APS nephropathy (APSN), corresponds to vaso-occlusive lesions of the intrarenal vessels, associating side-by-side, acute thromboses with chronic arterial and arteriolar lesions, leading to zones of cortical ischemic atrophy. A retrospective study of 114 lupus patients undergoing renal biopsy was undertaken to determine the following: (1) if APSN can be found in the course of systemic lupus erythematosus (SLE); (2) if certain clinical and biologic factors can permit the prediction of the presence of APSN; and (3) if APSN is a superadded renal morbidity factor in lupus patients. This study shows the following: (1) APSN occurs in SLE (32% of patients with renal biopsies) in addition to, and independently of, lupus nephritis; (2) APSN is statistically associated with lupus anticoagulant but not with anticardiolipin antibodies; (3) APSN is associated with extrarenal APS, mainly arterial thromboses and obstetrical fetal loss, but not with the venous thromboses of APS; (4) APSN is an independent risk factor, over and above lupus nephritis, that contributes to an elevated prevalence of hypertension, elevated serum creatinine, and increased interstitial fibrosis. Thus, it seems likely that, because of its associations with hypertension, elevated serum creatinine, and increased interstitial fibrosis, APSN may worsen the prognosis in these patients. APSN may also have therapeutic significance in that its recognition should permit a better balance between immunosuppressor and antithrombotic and/or vasoprotective therapy. Finally, this study suggests that APSN should be considered as an element to be included in the classification criteria of APS.

Sign in / Sign up

Export Citation Format

Share Document