CLINICOPATHOLOGICAL PATTERN AND OUTCOME OF PATIENTS WITH LUPUS NEPHRITIS: A SINGLE CENTRE STUDY AT BANGLADESH MEDICAL COLLEGE HOSPITAL.

Introduction:

Lupus nephritis (LN), an immune complex glomerulonephritis is a frequent and severe manifestation of SLE. The incidence and prevalence of LN are influenced by age , sex, ethnicity ,geographic region and a risk factor for CKD and ESRD.SLE patients with LN have high mortality ration than patients without nepthritis (6-6.8vs 2.4) ,with 14 times increase risk of CKD and 63 times risk of ESRD . Correlation between clinical and biochemical parameters with histological class is very important to achieve remission  which can reduced mortality . So This study was done to assess clinical ,biochemical and histological parameters and correlate with outcome

Methods:

This retrospective study was done among 465 patients with any form of renal involvement for which renal biopsy was done .Among all total 24 patients with lupus nephritis were included in this study .Clinical presentation ,biochemical and serological parameters including autoantibodies ( ANA, antidsDNA, anti smith antibody ) were assessed . Both light microscopy and Direct immunofluorescence evaluation were done in all cases. All patients were under regular follow up and outcome were assessed using clinical, biochemical and renal parameters .

Results:

Among total 24 patients  with Lupus Nephritis ,majority 87.5% (n=21) being female, Mean age 31.8 yrs ( range 12-55yrs). Seventy two percent from low socioeconomic status. Among all total eight (33.33%0 were previously suffering from systemic lupus erythematosus(SLE) and eleven (45.8%)patient presented with extrarenal features along with renal abnormalities. Among renal abnormalities most common presentation was nephritic syndrome (33.33%) followed by nephrotic syndrome 25% ,isolated proteinuria(20.8%),isolated hematuria(12.5%). Total two (8.33)patients presented with RPGN like feature and (Table :1).Total 11 patients had one or more associated extrarenal features . photosensitivity was most common feature followed by arthritis ,oral ulcer,serositis,malar rash(Table :2).total 3 patients presented with neurological fetures like convulsion and five patients with any pattern of hematological abnormality .According to ISN/RPS classification ,twelve(50%) patients found  Diffuse LN class iv followed by Focal LN class III( n=4), Mesangial proliferative LN  class II (n=4),Membranous LN class V(n=2) chronic sclerosing LN class VI (n=1).one patient were found histologically to be combined class IV and Class V LN (Table :3) . In DIF total six (25%) patients found full house deposition (IgA,IgG,IgM,C3,C1q). Among total 19 patients with class III, classIV and class V 12 patients received pulse methylprednisolone followed by oral steroid and MMF, and  7 patients received pulse methylprednisolone followed by oral glucocorticoid and monthly cyclophosphamide. No significant difference was found in outcome in both group. Total thirteen (54.2%) patients achieved complete remission during initial therapy with in average duration 3.2 months and six patients had relapse . Total four patient progressed to ESRD . (Table 4 ) . Over all patients presented with RPGN  progressed to ESRD and  total 3 patients died being mortality 12.5%.

Conclusions:

LN is a serious risk factor for the high mortality and morbidity . A proper management and regular follow up is required . In this single centre study we found that patients severe features during presentation and patients with class IV and combined class IV and class V were prone to progress to ESRD and mortality of our study was 12.5%.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.