Correlation between Clinical Manifestations for Patients with Lupus Nephritis and Pathological Activity or Chronicity Indices.
Background: Systemic lupus erythematosus is a disorder of the immune system with many clinical manifestations. Lupus nephritis severity has been shown to correlate to clinical manifestations in research populations. At renal biopsy, a higher microscopic hematuria, impaired glomerular filtration rate, proteinuria, anemia, hypoalbuminemia, hypertension, and the presence of positive anti-deoxyribonucleic acid antibody were all associated with the worst class, that is, class IV.These parameters were also correlated with high renal pathological activity, and chronicity indices in patients with lupus nephritis.
Aim of the currents study: is to find the correlation between clinical manifestations and disease pathological activity and chronicity indices.
Patients and methods: Over a period of two years started from 2015 to 2017, we collected kidney biopsy specimens from thirty-seven systemic lupus erythematosus patients, 28 were females and 2 were males, who were referred to AL-kafeel center for nephrology and kidney transplantation, Karbala holy, Iraq. All patients were diagnosed as systemic lupus erythematosus if fulfilled ≥4 American college of rheumatology criteria for systemic lupus erythematosus. The activity and chronicity scoring indices are based on the percentage of glomeruli with each feature in the biopsy on a 0 to 3 scale, with a score of 0 = not present, 1 = <25% glomeruli, 2 = 25-50% glomeruli, and 3 indicating >50% glomeruli. Indicators of disease chronicity index include the total percentage of global glomerulosclerosis, fibrous crescents, tubular atrophy, and interstitial fibrosis. Indicators of disease activity index include endocapillary hypercellularity, neutrophils or karyorrhexis within glomerular capillary loops, fibrinoid necrosis, hyaline deposits, cellular or fibro cellular crescents, and interstitial inflammation. We use Statistical package for social sciences version 24 computer program by choosing chi square test, Pearson correlation, and single table student “T” test. P values <0.05 was considered statistically significant.
Results: the chronicity index score increased with disease duration with more than 55 percent of patient have the highest degree of fibrosis. The incidence of anemia increases with presence of high scores of chronicity index. With more than 40 percent of patients with lupus nephritis have glomeruli fibrosis percentage between 25-50%. Patients with lupus nephritis who presented with chronic kidney disease have a significantly high disease chronicity index on their kidney biopsies and constitute more than 60%, p value <0.05. Malar rash has significant correlation with both activity and chronicity indices. There was no significant correlation between gender, arthritis, edema, with both activity and chronicity indices.
Discussion: more than two third of patients with LN in this study have stage 3 CKD, and anemia. This is due to erythropoietin deficiency and other causes. earlier prevalence of CI score, this may be related to the delayed presentation of patients to medical care and therefore delayed doing kidney biopsy. On the other hand, a possible environmental pollution could have a detrimental effect on the disease progression. Malar rash as a marker of disease activity on the top of chronic underlying pathology.
Conclusions, and recommendations: concludes that the presence of anemia at time of consultation of LN patients is a bad prognostic sign. Further studies to identify the causes of earlier onset of high CI in kidney biopsy of Iraqi patients are recommended
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