Correlation between Clinical Manifestations for Patients with Lupus Nephritis and Pathological Activity or Chronicity Indices.

  • riad abbood
  • Aqeel abbas matrood, internist

Abstract

Abstract:


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

References

1. Abujam, B., S. Cheekatla, and A. Aggarwal, Urinary CXCL-10/IP-10 and MCP-1 as markers to assess activity of lupus nephritis. Lupus, 2013. 22(6): p. 614-623.
2. Mok, C.C., Biomarkers for lupus nephritis: a critical appraisal. BioMed Research International, 2010. 2010.
3. Almaani, S., A. Meara, and B.H. Rovin, Update on lupus nephritis. Clinical Journal of the American Society of Nephrology, 2017. 12(5): p. 825-835.
4. Contreras, G., Pardo, V Cely, C Borja, E., Factors associated with poor outcomes in patients with lupus nephritis. Lupus, 2005. 14(11): p. 890-895.
5. Satirapoj, B., P. Tasanavipas, and O. Supasyndh, Clinicopathological correlation in asian patients with biopsy-proven lupus nephritis. International journal of nephrology, 2015. 2015.
6. Shariati‐Sarabi, Z., Ranjbar, Amin Monzavi, Seyed M., Analysis of clinicopathologic correlations in I ranian patients with lupus nephritis. International journal of rheumatic diseases, 2013. 16(6): p. 731-738.
7. Pons-Estel, G.J., Ugarte-Gil, Manuel F., 289 Comparison of ACR 1982/1997 and EULAR/ACR classification criteria for systemic lupus erythematosus in two multiethnic cohorts. 2019, Archives of Disease in childhood.
8. Dooley, M., C. Aranow, and E. Ginzler, Review of ACR renal criteria in systemic lupus erythematosus. Lupus, 2004. 13(11): p. 857-860.
9. Levey, A.S., De Jong, Paul E Coresh, Josef. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney international, 2011. 80(1): p. 17-28.
10. Amann, K. and C.S. Haas, What you should know about the work-up of a renal biopsy. Nephrology Dialysis Transplantation, 2006. 21(5): p. 1157-1161.
11. Bajema, I.M., Wilhelmus, Suzanne. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices. Kidney international, 2018. 93(4): p. 789-796.
12. Hahn, B.H., Harrison's principles of internal medicine. 19th ed. 2015: McGraw-Hill Education.
13. Giannouli, S., Voulgarelis, Michael Ziakas, Panayiotis D., Anaemia in systemic lupus erythematosus: from pathophysiology to clinical assessment. Annals of the rheumatic diseases, 2006. 65(2): p. 144-148.
14. Guo, Q., Lu, Xuehong Miao, Lining. Analysis of clinical manifestations and pathology of lupus nephritis: a retrospective review of 82 cases. Clinical rheumatology, 2010. 29(10): p. 1175-1180.
15. Al-Hadad, H.S., Matrood, Aqeel Abbas Almukhtar, Maha Abdalrasool Kehiosh, Haider Jabur Al-Saegh, Riyadh Muhi, Correlation Between Serological Makers and Immunofluorescence Deposits in Kidney Tissue of Patients with Lupus Nephritis. International Journal of Drug Delivery Technology, 2019. 9(02).
16. Nasri, H., Ahmadi, Ali Baradaran, Azar Momeni, Ali, Clinicopathological correlations in lupus nephritis; a single center experience. Journal of nephropathology, 2014. 3(3): p. 115.
17. Ballou, S.P., M.A. Khan, and I. Kushner, Clinical features of systemic lupus erythematosus. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 1982. 25(1): p. 55-60.
18. McCarty, G., J. Harley, and M. Reichlin, A distinctive autoantibody profile in black female patients with lupus nephritis. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 1993. 36(11): p. 1560-1565.
19. Boilard, E., P. Blanco, and P.A. Nigrovic, Platelets: active players in the pathogenesis of arthritis and SLE. Nature Reviews Rheumatology, 2012. 8(9): p. 534.
Published
2020-06-18
How to Cite
ABBOOD, riad; MATROOD, Aqeel abbas. Correlation between Clinical Manifestations for Patients with Lupus Nephritis and Pathological Activity or Chronicity Indices.. Kerbala journal of medicine, [S.l.], v. 13, n. 1, p. 2260 - 2266, june 2020. ISSN 1990-5483. Available at: <https://journals.uokerbala.edu.iq/index.php/kj/article/view/785>. Date accessed: 23 oct. 2020.
Section
Articles