SLE Nephritis Clinical Features and Renal Lesion: Tripoli Central Hospital Experience - Abstract
Background: Lupus nephritis (LN) is a known complication of systemic lupus erythromatosis (SLE).
Aim: To study the relationship between clinical features of SLE and LN classes at presentations.
Method: Patients’ files were reviewed retrospectively for the clinical symptoms, signs, laboratory results and histopathology reports of kidney biopsy of SLE patients for 8 years. All patients had CBC, bleeding and clotting time. Blood pressure measured before conducting percutaneous renal biopsy (PRB).
Statistical analysis: Data was collected and analyzed by IBM-SPSS version19.0 (SPSS, Chicago, IL, USA).Student’s t-test, one-way ANOVA and analysis of variance were used for statistical analysis. P < 0.05 was considered statistically significant.
Results: One-hundred twenty seven SLE patients files’ were reviewed, 51 patients had been diagnosed as LN after their PRB specimens examined by pathologist. Patients were 44 females (86.3%), 7 males (13.7%), with a mean age of 31 year ± 2.3 (standard error of mean). Bilateral lower limbs (BLL) edema and hypertension (HTN) reported in 16 patients (31%), BLL edema and hematuria detected in 12 patients (24%), BLL edema only reported in 7 patients (14%). Generalized edema plus hematuria described in 6 patients (12%). Oliguria with muscle weakness and generalized edema described in 4 patients (8%).Muscle weakness and generalized edema reported in 3 patients (6%), and BLL edema plus face puffiness only reported in 3 patients (6%). White blood cell count (WBC) mean was 8.46 x 103 ± 0.57, ranged between 4.8 -13.0 x 103/ µl. Hemoglobin mean was (11.4g ± 0.22), ranged (9.5 – 13g/dl). Platelets mean was 170 x 103/µl ± 10.3, ranged between 124 – 301x 103/µl. Erythrocyte sedimentation rate (ESR) ranged between 2.00 – 84.00 mm after 1st hour, with a mean of 40 ± 5.86.Mean protein excretion in urine/24 hours was 2.22g/L ± 0.19, 0.30 – 2.22 g/L. LN activity index mean was (5 ± 1.0) ranged0.00 – 14. Chronicity index mean (1.95 ± 0.52), and ranged between 0.00 – 10.00. Histopathological findings were; Class I reported in 7 patients (14%), class II in 11 patients (22%).Class III reported in 5 patients (10%), class IV in 18 patients (35%) and class V in 10 patients (20%). Advanced sclerotic LN (class VI) was not described in the studied patients. Patients’ age affected protein excretion in 24hrs urine, LN activity and chronicity index significantly (P = 0.02, P< 0.0001, P< 0.0001) respectively. Multivariate analysis revealed significant correlation between LN classes and protein excretion in urine/day, i.e. class III, IV and V had significantly increased protein excretion in urine P = 0.04, 0.025 and 0.021respectively. LN class IV associated significantly with BLL edema only, and with BLL edema plus facial puffiness at presentation (p = 0.01, P=0.02).
Conclusion: Clinical feature and 24 hours protein excretion in urine were related significantly to LN classes and patients’ age at presentation. Early detection of clinical SLE features, and LN classes will reduce subsequent complications and health services cost