A clinicopathological study of 48 cases of lupus nephritis
Journal Title: Medpulse International Journal of Pathology - Year 2017, Vol 3, Issue 1
Abstract
Background: Systemic lupus erythematosus is a multi-systemic disorder which commonly affects the kidneys and remains the most dangerous life threatening complication.1Renal manifestationsare highly variable and patients present with a wide range of symptoms ranging from asymptomatic proteinuria to renal insufficiency which ends up in dialysis.2,3 Objective: To correlate the clinical, laboratory and histopathological findings in patients with different classes of lupus nephritis according to the WHO and the ISN/ RPS 2003 classifications Materials and Methods: Study population: Patients from Nephrology department, Government Medical College, Kottayam with diagnosis of suspected Lupus Nephritis detected on clinical and laboratory examinations. The study was observational study conducted in departments of Nephrology and Pathology, Medical College Hospital- Kottayam from 2010 to 2012. All diagnosed cases of Lupus Nephritis was included while Pregnant women with Coagulopathy and those are not willing to participate was exclude from study. Indication for Renal biopsy in Patients with proteinuria >300 mg/day and Abnormal urinary sediments The sample size was 48 cases of clinically suspected Lupus Nephritis during the year 2010 to 2012 Results: The most common clinical symptom in these patients was Edema (67%) followed by Hematuria(51%). The mean systolic blood pressure(SBP) was highest for class IV+V (146.36mmHg) followed by class IV(140.63 mm Hg).Other classes (III,III+V,V,VI) had comparatively lower SBP (128.10mm Hg).The mean Diastolic blood pressure (DBP) was highest for class IV+V (87.5mmHg). The mean serum Creatinine levels for different classes of LN were as follows: class IV (1.88 mg/dl) followed by class IV+V (1.27 mg/ dl). The mean Proteinuria for different classes were as follows: Highest for class IV+V(5.10g/d).Averageof all classes was 2.78 g/d. The mean Activity indices of different classes of LN were assessed and found highest for class IV+V(8.68), followed by class IV (8.36) and Other classes (1.74). The mean Chronicity indices of different classes of LN were assessed and found highest for class IV(1.16), followed by class IV +V(1.10). Conclusion: There was a strong positive correlation between clinical features as measured by proteinuria, systolic blood pressure and histological findings in proliferative glomerulonephritis. Despite the above positive result, there was no strict correlation between the Clinico biological manifestations and the histological type of LN. There was no association between increased creatinine level and interstitial fibrosis, increased systolic blood pressure and segmental sclerosis. Out of 48 cases, only 40% of cases had concordant clinical and biopsy diagnoses. Even the patients without clinically manifest renal disease often had mesangial immune deposits, therefore the clinicobiological picture cannot be considered predictive for the severity of the histological damage. Histopathological exam is mandatory for the assessment of any patient with LN as it confirms the positive diagnosis of lupus renal disease, determines the type, activity and stage that cannot be accurately predicted on the basis of clinical manifestations, thus providing prognostic data and guides in determining appropriate therapy.
Authors and Affiliations
C R Ajeeth Kumar, Lillykutty Pothen, Karthikeyan TM
Keywords
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