Study on Systemic Manifestations of Cutaneous Lupus Erythematosus with Special Reference To Renal Involvement.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2019, Vol 4, Issue 2
Abstract
Background: This study was done to find out presence or abscence of various system involvement of body in patients with cutaneous lupus erythematosus & presence of immunological markers & pattern of positivity with special reference to spectrum renal involoement among them. Methods:79 pts of Clinically diagnosed cases of cutaneous LE having LE specific skin lesions as classified by Gilliam’s criteria & indeterminate cases diagnosis was done by histopathology of skin lesions were included in this study after considering exclusion criteria over a period of one year. Patients having condition like DM, hypertension, UTI and taking nephrotoxic drugs like acyclovir, amphotericin B, anticancer drugs like cisplatin were excluded.Detailed history,physical examinations, routine blood,urine investigations & serum C3,ANA titre-pattern,anti ds DNA,histopathology of skin lesions and kidney biopsy & histopathology of biopsy specimen were done as per proforma & data were analyzed with appropriate statistical tests to determine the significance and power of the study. Results: The study population had male:female ratio of 4:75. Mean age of study population were 27.58. In our study among the 79 patients 32 patients(40.51%) had pure ACLE, 19 patients(24.05%) had SCLE, 15 patients(18.99%) had pure CCLE. In patients with systemic involvement, 92.41% had renal involvement, 58.9% had GI involvement, 38.36% had haematological involvement, 21.92% had serositis, 13.7% had neurological involvement and 10.96% had lymphoreticular involvement.In our study, ACLE lesions were predominant in all the system involved and highest being in patients those had neurological involvement(70%). Mean 24 hour urinary protein was much higher(1.52gm) in patients with systemic involvement than those without systemic involvement(0.84mg). Higher percentage of increased kidney echogenicity and altered CMD were found to be associated with serositis and in patients with renal involvement. Among the patients with different systemic involvement predominant ANA titres were 1/640 followed by 1/320 & predominant pattern was homogenous followed by speckled pattern. In our study, population 89.04% patients were anti-dsDNA positive and anti-dsDNA positivity slightly higher in patients of CLE without systemic involvement(83.33%) than those with systemic involvement(82.19%).%). In patients with renal involvement 82.19% were anti-dsDNA positive. Conclusion: This necessitates that presence of fever, psychosis, history of seizure , hepatosplenomegly, lymphadenopathy in patients presenting with cutaneous lupus erythematosus should alert the physician regarding systemic involvement. Acute, subacute, chronic cutaneous lupus erythematosus and acute and chronic cutaneous lupus erythematosus overlap, all had significant association with renal biopsy class IV. This signifies that irrespective of type of cutaneous lupus erythematosus all patients of CLE should be evaluated by renal biopsy and should not delayed till other manifestation revealed. Renal biopsy should be done in all patients of suspected SLE even anti-dsDNA is negative as our study showed, all anti-dsDNA negative patients had lupus nephritis in renal biopsy.
Authors and Affiliations
Dr. Avijit Saha
Keywords
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