Lupus nephritis: frequency, histological forms and Predictors of renal disease

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Published Feb 20, 2015
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Vol. 92 No. 10 (2014): Issue Oct 2014

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En-Nasri Sana
Fouad Zineb
Fadili Wafaa
Hassani Selma
Amal Said
Essaadouni Lamiaa
Laouad Inass

Abstract

Background: Lupus nephritis is a common and serious damage in systemic lupus erythematosus. The aim of our study is to define the frequency and to identify the predictors of lupus nephritis in patients with systemic lupus erythematosus.

Methods: multicenter retrospective study on all systemic lupus erythematosus patients followed between 2005 and 2012. We analyzed the epidemiological, clinical and biological presentation at admission and during follow-up. We have identified two groups of patients: group 1 involving systemic lupus erythematosus without renal disease, group 2 : patient with lupus nephritis.

Results: We collected 105 patients including 100 women, 41 (39%) with lupus nephritis occurred after a period of 30±10 months of development of lupus. 4 patients (3%) were initially presented with acute renal failure requiring hemodialysis. The pathological findings of renal biopsy is respectively: class IV, III and II in 19 patients (63.3%), 4 patients (13.3%), and 4 patients (13.3%). Our patients with lupus nephritis received various treatment regimens: 38 patients (92.7%) received corticosteroids and combined with cyclophosphamide in 33 (80.5%) cases. Only young age, anemia and antinuclear antibodies were correlated with the risk of occurrence of renal damage. Predictors of the severity of lupus nephritis were the short time of occurrence of renal and renal failure.

Conclusion: Lupus nephritis in our series is characterized by a severity of the clinical and biological explained by the frequency of proliferative forms, hence the necessity for early and adequate management.

Keywords:

Lupus - Lupus nephritis - Predictors.

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References

  1. Meyer.O. Lupus érythémateux systémique. EMC-Rhumatologie Orthopédie 2 ; 2005 1-32.
  2. Michel M, Meyer O, Frances C,Tournier-Lasserve E,Piette JC. Bases immunogénétiques du lupus systémique chez l homme. Revue Med Interne 1998 ;19 :726-30.
  3. Cross J, Jayne D. Diagnosis and treatment of kidney disease. Best Pract Res Clin Rheumatol 2005;19:785-98
  4. Ponticelli C, Zucchelli P, Moroni G. Long-term prognosis of diffuse lupus nephritis. Clin Nephrol 1987; 28: 263-271.
  5. Bono L, Cameron JS, Hicks JA. The very long-term prognosis and complications of lupus nephritis and its treatment. Q J Med 1999; 92: 211-218.
  6. Donadio JVJ, Hart GM, Bergstralh EJ, Holley KE. Prognostic determinants in lupus nephritis: a long-term clinicopathologic study. Lupus 1995; 4: 109-115.
  7. Cameron JS. Lupus nephritis. J Am Soc Nephrol 1999;10:413-24.
  8. Barr G, Seliger S, Appel G, Zuniga R, D'Agati V, Radhakrishnan JS. Prognosis in proliferative lupus nephritis: the role of socio-economic status and race/ethnicity. Nephrol Dial Transplant (2003) 18: 2039- 2046.
  9. Bastian HM, Roseman JM, McGwin Jr G, Alarcon GS, Friedman AW, Fessler BJ. Systemic lupus erythematosus in three ethnic groups. Risk factors for lupus nephritis after diagnosis. Lupus 2002;11:152-60.
  10. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P. Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1000 patients. Medicine 1993;72:113-24.
  11. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P. Morbidity and mortality in systemic lupus erythematosus during a 10- year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine 2003;82:299-308
  12. Vlachoyiannopoulos PG, Karassa FB, Karakostas KX, Drosos AA, Moutsopoulos HM. Systemic lupus erythematosus in Greece. Clinical features, evolution and outcome: a descriptive analysis of 292 patients. Lupus 1993;2:303-12
  13. Seligman VA, Suarez C, Lum R, Inda SE, Lin D, Li H. The Fcgamma receptor IIIA-158F allele is a major risk factor for the development of lupus nephritis among Caucasians but not non-Caucasians. Arthritis Rheum 2001;44:618-25.
  14. Seligman VA, Lum RF, Olson JL, Li H, Criswell LA. Demographic differences in the development of lupus nephritis: a retrospective analysis. AmJ Med 2002;112:726-9.
  15. Hopkinson ND, Jenkinson C, Muir KR, Doherty M, Powell RJ. Racial group, socioeconomic status, and the development of persistent proteinuria in systemic lupus erythematosus.Ann Rheum Dis 2000;59:116-9.
  16. Houng DL, Papo T, Beaufils H, Wechsler B, Blétry O, Baumelou A. Renal involvement in systemic lupus erythematosus. Medicine 1999;78:148-66.
  17. Fremeaux-BacchiV, Noel LH, Schifferli JA. No lupus nephritis in the absence of antiC1q autoantibodies? Nephrol Dial Transplant 2002;17: 2041-3
  18. Bujan S,Ordi-Ros J,Paredes J,Mauri M,Matlas L, Cortes J. Contribution of the initial features of systemic lupus erythematosus to the clinical evolution and survival of a cohort of Mediterranean patients. Ann Rheum Dis 2003;62:859-65.
  19. Davison A, Cameron JS, Grunfeld JP, Kerr DNS, Ritz E, Winearls CG. Factors predictive of outcome in severe lupus nephritis. Am J Kidney Dis 1997:904-14.
  20. Waldman M, Madaio MP. Pathogenic auto antibodies in lupus nephretis. Lupus 2005;14:19-24.
  21. Peng SL, Craft J. T cells in murine lupus:propagation and regulation of disease. Mol Biol Rep 1996;23:247-51
  22. Isenberg D, Rahman A. Systemic lupus erythematosus-2005 annus mirabilis? Nat Clin Pract Rheumatol 2006;2:145-52.
  23. . Crispin JC. Pathogenesis of human systemic lupus erythematosus:recent advances. Trends Mol Med 2010;16:47-57.
  24. Amoura Z, Piette JC, Bach JF, Koutouzov S. The key role of nucleosomes in lupus. Arthritis Rheum 1999;42:833-43.
  25. Beji S, Kaaroud H, Benmoussa F, Abderrahim E, Goucha R, Ben Hamida F, Hedri H, El Younsi F, Ben Abdallah T, Kheder A, Ben Maiz H. La Revue de Médecine Interne 2005; 26: 8-12
  26. Mathian A, Weinberg A, Gallegos M, Banchereau j, Koutouzov S. IFNalpha induces early lethal lupus in preautoimmune ( New Zealand Black×New Zealand White) F1 but not in BALB/C mice. J Immunol 2005;174:2499-506.
  27. Batto M. Homozygous C1q deficiency causes glomerulonephritis associated with multiple apoptotic bodies. Nat Genet 1998;19:56-9.
  28. Molino C, Fabbian F, Longhini C. Clinical approach to lupus nephritis: Recent advances. European Journal of Internal Medicine 20 (2009) 447-453.
  29. Kewalramani R, Singh AK. Immunopathogenesis of lupus and lupus nephritis : recent insights. Cur Op Nephrol Hypertens 2002;11:273-7.
  30. Berden JH. Lupus nephritis. Kidney Int, 1997 ; 52 : 538-558.
  31. Van Den Born J, Van Den HeuveL LP, Bakker MA. Distribution of GBM heparan sulfate proteoglycan core protein and side chains in human glomerular diseases. Kidney Int, 1993 ; 43 : 454-463