CLINICOPATHOLOGICAL PROFILE AND OUTCOME OF LUPUS NEPHRITIS PATIENTS IN ANDHRA PRADESH INDIA

 

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CLINICOPATHOLOGICAL PROFILE AND OUTCOME OF LUPUS NEPHRITIS PATIENTS IN ANDHRA PRADESH INDIA

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Uttara
Das
Uttara Das uttaradas806@gmail.com AIIMS MANGALAGIRI Nephrology Guntur India *
TIMITROV Periyannan timitrov@aiimsmangalagiri.edu.in AIIMS MANGALAGIRI Nephrology Guntur India -
AMULYA kasukurthi amulya.ks97@gmail.com AIIMS MANGALAGIRI Nephrology Guntur India -
SWARNALATHA Gourishankar swarnalatag@gmail.com APOLLO HOSPITALS Histopathology HYDERABAD India -
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To characterize the demographic, clinicopathological, treatment response, and complication profile of patients with lupus nephritis(LN) of the the population from Andhra Pradesh , Southern part of India

This retrospective analysis included 57 SLE LN cases. Demographic data, histopathological classes (based on 54 biopsies), immunofluorescence (IF) findings (48 cases), treatment response at various follow- up periods (6-36 months), and recorded complications were analysed. Severe lupus nephritis cases were treated as per the NIH protocol, with induction therapy consisting of intravenous methylprednisolone (30 mg/kg body weight) administered for three consecutive doses at initiation, followed by monthly intravenous cyclophosphamide pulses for six months. Maintenance therapy included mycophenolate mofetil and a tapering dose of oral prednisolone, along with other supportive medications.

In these 57 cases mean age was 30.6yrs (SD:10yrs; Range 15 to 54 is 39), Female – to- male ratio was 10.4:1. 

Histopathology: The most common classes were Class IV (Diffuse LN) and Class V (Membranous LN), each accounting for 25.92% of cases. Class III for 24.07%, Mixed Classes (III + IV and IV + V) accounted for 5.55% each, Class II for 9.25%and Class I and VI for 1.85% each.

Immunofluorescence: A “ full house” pattern was observed in 39.5% of cases. Lambda light chain deposition (54.1% at 3+ and above) was more frequent than Kappa (41.6% at 3+ and above). IgG was the most common immunoglobulin deposited (72.9% at 3+ and above) and IgM (4.1% at 3+ and above). IgA was negative in 20.8% of cases. C1q (35.4% at 3+ and above), C3c (25% at 3+ and above).

Response to treatment: Excluded cases who lost follow up (15 cases) and cases whose follow up was less than 6 months (6 cases). Out of remaining 36 patients Complete remission (CR) seen in 38.2%, Partial remission (PR) in 50%, no response (NR) in 8.33%, death in 5.55% cases in first 6 months. Out of 25 follow up cases in 12 months CR occurred in 48% cases, PR in 32%NR in 12%relapsein 2.8%. Out of 17 follow up cases in 18 months CR occurred in 58.8% cases, PRin 29.4%relapse in 11.7%. Out of 11 follow up cases in 24 months CR occurred in 72% cases, PR in 18.8%NR in 9.09%. Out of 5 follow up cases in 30 months CR occurred in 80% cases, relapse in 20%. Out of 3 follow up cases in 36 months CR occurred in 66.6% cases, relapse in 33.3%.

Complications: The most frequent complication were Leucopenia (15.7%), and Herpes (10.5%). UTI (5.26%); Tuberculosis and candidiasis (3.5% each); Toxoplasmosis, thrombocytopenia, B/L AVN and septic arthritis in (1.7% each).

The  LN cohort in southern part of India  predominantly presented with Diffuse proliferative and membranous histopathological classes(class IV and V), demonstrating a significant female predominance. Immunofluorescence frequently showed IgG, C1q and a dominant lambda light chain deposition. Early treatment showed promising complete remission  rates and CR rate increased with duration of treatment, though a considerable proportion experienced relapse during extended follow-up, highlighting the need for vigilant monitoring and tailored maintenance therapy. Leucopenia and Herpes infections were the most common adverse events.

Kewords