Rheumatologie: Aktuelle Forschung
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Abstrakt

Predictive Factors and Long Term Outcome in Lupus Nephritis in Libya

Fathia Ehmouda Zaid and Mabroka Bushiha Salem

Lupus Nephritis (LN) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus. Prompt recognition and treatment of renal disease is important, as early response to therapy is correlated with better outcome. The main purpose of this study is evaluation lupus nephritis, outcome of lupus nephritis, and studies predictive factors in lupus nephritis are improved outcome.
Patient and methods: Follow up study patients diagnosed as Systemic Lupus Erythematosus (SLE) according to the American College of Rheumatology (ACR), from the registration file of Rheumatology clinic, These patients were studied clinically for the presence of lupus nephritis, laboratory test CBP, ESR, RFT, Urine sedimentation, USS Abdomen, Doppler renal and use immunology test ANA positively was more than 1:160, anti-DNA Serum compliment levels (C3, C4), anti-ENA.
Result: Clinical presentation of lupus nephritis was asymptomatic lupus nephritis is (6.6%), Nephritis lupus nephritis (24 h urine collection<3 g/d) is (36.8%), Nephrotic disease (24 h urine collection ≥ 3 g/d) is (28.9%) and acute renal failure is (27.6%), Albumin urine collection g/d range from 0.6-6 g/24 h, M=2.1 ± 1.1, blood urea ranged from 18-200 mg/dl, M=90.9 ± 47.6, serum creatinine was 0.5-6.7 mg/dl, M=2.6 ± 1.8, Hypertension patients of lupus nephritis was (89.5%). Positive ANA was (93.4%), positive Ds DNA was (94.7%), and low complement C3, C4 was (94.7%) and positive anti cardiolipin antibody AGL was (23.7%) recurrent attack lupus nephritis was (14.5%). The renal biopsy was done found diffuse proliferative lupus nephritis was (45.5%), Focal proliferative lupus nephritis was (20.8%) and mesangial proliferative lupus nephritis was (16.9%). management of lupus nephritis and choice of therapy according guideline European League against Rheumatism (EULAR), patients were received azathioprine (13.2%), IV injection Cyclophosphamide therapy was (21.1%), mycophenolate mofetil was (55.3%) and injection rituximab was (10.5%). Outcome lupus nephritis was complete response (64.5%), Partial response was (13.2%), resistance lupus nephritis was (22.1%), end stage renal failure on hemodialysis was (7.9%), conservative chronic renal failure was (14.5%) and mortality of lupus nephritis was (13.2%)
Conclusion: Most common type diffuse proliferative lupus nephritis followed Focal proliferative lupus nephritis then mesangial proliferative lupus nephritis, induction therapy with mycophenolate mofetil or cyclophosphamide or rituximab in inducing complete remission of lupus nephritis is 64%. Even with standard therapy the end stage renal failure was (14.5%) and mortality of lupus nephritis was (13.2%) in this study. The impact of several factors like sex, age, race, duration of lupus nephritis, serum urea, serum creatinine and renal biopsy have statistical significance correlation and predictive effect on outcome lupus nephritis.