Clinical, laboratory, histopathology characteristics and correlations of lupus nephritis patients- A single Center experience

Background: Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus (SLE).The world Health Organization (WHO) and International Society of Nephrology/Renal Pathology Society (ISN/RPS 2003) can correlate the histopathology pattern with clinical renal syndrome and provide valuable information regarding diagnosis, prognosis and management guidelines. Objective: To evaluate the main clinical, laboratory and histopathological characteristics of lupus nephritis (LN), and find the clinicopathologic correlation of renal biopsy lupus classification. Patients and methods: This study comprised a total of 38 adults LN patients, 36Females (94.7%), and 2 males (5.3%) with female to male ratio (18:1), mean age of 26.7 ± 8.95ys, urban patients 24 (63.2%) and rural 14 (36.8%). All patients were subjected to complete clinical, laboratory, and native renal biopsy histopathological evaluation through one year. Biopsies were examined and categorized accor¬ding to ISN/RPS 2003 classifications. Results: The most frequent presenting features of SLE were mucocutaneous found in (78.9%), serositis (47.4%) and hematological disorders (23.7%).The frequencies of LN histopathological patterns were as follow: diffuse proliferative LN (class IV) found in 21 cases (55.3%), followed by class III found in 12 patients (31.5%) then class V in 4cases (10.5%) and lastly class II found in 1case (2.6%). A significant association found between nephrotic syndrome, edema and class V LN (p = 0.016 & p=0.024) respectively, also a significant associations between nephritic syndrome, hypertension, decreased estimated GFR and microscopic hematuria and class IV LN (p =0.048, p =0.01, p = 0.04 & p=0.02) respectively. While no significance found between LN class III or IV and each of arthritis, CNS, serositis, SLE disease activity index (SLEDAI), antiphospholipid syndrome (APS) and cutaneous manifestations. Conclusion: Our study demonstrated that diffuse proliferative LN class IV was the predominant pattern followed by class III. Obvious correlation found between clinical, laboratory and renal histopathology of lupus nephritis. Renal biopsy remains the corner stone in diagnosis, management and prognosis of the disease.