MANAGEMENT AND CLINICAL OUTCOME OF SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS; AT NEPHROLOGY UNIT , ZAGAZIG UNIVERSITY HOSPITALS: A ONE YEAR STUDY.

Background: Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disorder with a broad spectrum of clinical presentations encompassing almost all organs and tissues. Renal disease in SLE carries a significant morbidity and mortality. Despite treatment advances, up to 26% of patients with lupus Nephritis (LN) still develop End Stage Renal Disease (ESRD). Objectives: To specify the best lines of management for SLE, those directly influence the outcome of SLE patients in our unit, Also to follow up and compare between the favorable and the unfavorable SLE activity outcomes. Subjects and methods: Our study was an interventional non randomized clinical trial conducted at Nephrology Unit, Internal Medicine Department, Zagazig University Hospitals, including 64 adult participants diagnosed with SLE who gave their informed consent. All subjects were divided according to their renal biopsy into three groups, the 1st group was 21 patients (2 males and 19 females) with class III (LN), the 2nd group was 28 patients (3 males and 25 females) with class IV (LN) and the 3 rd group was 15 patients (2 males and 13 females) with class V-proliferative (LN), each group was subdivided into 2 sub-groups according to the induction treatment used that was either oral mycophenolate mofetil (MMF) or iv cyclophosphamide (CYC) . Results: (LN) class IV is the commonest, proteinuria was higher in class V-proliferative (V+ III/IV) (LN) group than other 2 groups and serum albumin was lower than the other 2 groups. The rates of response have been 31.3 % for complete remission (CR), 45.3% for partial remission (PR) , 20.3 % of patients reported treatment failure, 10.9 % developed ESRD while 17.2% died .The highest rate of treatment response either CR or PR was noticed with class III (LN) ,While the highest rate of non responders was noticed with class IV (LN) & class (V-III/IV) (LN). MMF showed superiority over CYC.