Significance of renal staging in lupus nephritis in relation to clinical manifestations, kidney function and serum autoantibodies profile

Abstract EN

Objective : To assess the significance of renal staging in lupus nephritis in relation to clinical manifestation, kidney function and serum auto antibodies profile in patients with systemic lupus erythematosus (SLE) Methods : Thirty-eight patients with SLE nephritis subjected to renal biopsy were included in this study.

The biopsies were classified according to WHO classification for renal staging.

The activities of the disease were recorded using BILAG scoring for activity.

Immunological profile include anti-dsDNA, ANA, C3, C4, Immunoglobulin G, M, A, were assessed and the kidney function includes serum creatinine, urea, 24 hours urinary protein as well as total serum protein and serum albumin were measured.

Results : There was significance increase in creatinine, 24-hour urinary protein excretion and anti-ds DNA in lupus nephritis patients than those with extra-renal lupus (controls).

In comparative study between different histological classes we found a significant elevation of serum creatinine in stage V glomerulonephritis (GN).

Significant increased urinary protein per 24 hours excretion in stage III and IV GN.

Significant increase anti-dsDNA in stage IV GN Significant increase the incidence of renal insufficiency with stage V GN (p < 0.05) Significant positive correlation between the histological stages of lupus nephritis and renal insufficiency and serum creatinine level with insignificant positive correlation with activity score, anti-dsDNA, C3, C4, immunoglobulin level IgG, M, and A.

Conclusion : Renal biopsy and histological staging has no significant relation to other parameters of clinical activity of systemic lupus erythematousus.

Close monitoring of urine for protinurea, serum creatinine levels and anti-ds DNA especially in histological stages IV and V GN of renal biopsy may play a role in prediction of renal insufficiency in lupus nephritis.