THE PREVALENCE OF DIFFERENT CLASSES OF LUPUS NEPHRITIS BASED ON ISN/RPN 2003 CLASSIFICATION SYSTEM KEEPING RENAL BIOPSY AS STANDARD FOR DIAGNOSIS
Main Article Content
Keywords
Lupus Nephritis, SLE, Renal biopsy, ISN/RPS 2003, Serum urea, Proteinuria
Abstract
Background: The most common symptom of systematic lupus erythematosus (SLE) is lupus nephritis (LN), with an incidence of 50–70%. Kidney biopsy, which enables histology-based classification in accordance with World Health Organization (WHO) standards declared in 1982, is the main method used to examine LN. This study aimed to classify LN according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification system and determine the prevalence of different classes.
Methods: The Nephrology Department at a tertiary care hospital in Islamabad, Pakistan, conducted a retrospective observational study between February 2012 and April 2018. The study included adult participants (age > 18 years) with a confirmed diagnosis of lupus nephritis and individuals who had undergone renal biopsy. Patient data were obtained from hospital records and analyzed thoroughly.
Results: A total of 256 biopsies were examined, and 40 cases of LN were confirmed. It is more prevalent in females (7:1), with class IV having the highest incidence rate. There was no statistically significant link between LN and urea, but proteinuria and creatinine values were significant.
Conclusion: It is essential to promptly recognize renal failure in SLE patients. Lupus nephritis can be diagnosed and treated using a kidney biopsy.
References
2. Saxena R, Mahajan T, Mohan C. Lupus nephritis: current update. Arthritis Res Ther [Internet]. 2011;13(5):240. Available from: https://doi.org/10.1186/ar3378
3. Weening JJ, D’agati VD, Schwartz MM, Seshan S V, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int [Internet]. 2004;65(2):521–30. Available from: https://www.sciencedirect.com/science/article/pii/S0085253815497340
4. Bihl GR, Petri M, Fine DM. Kidney biopsy in lupus nephritis: look before you leap. Nephrol Dial Transplant [Internet]. 2006 Jul 1;21(7):1749–52. Available from: https://doi.org/10.1093/ndt/gfl159
5. Markowitz GS, D’Agati VD. The ISN/RPS 2003 classification of lupus nephritis: An assessment at 3 years. Kidney Int [Internet]. 2007;71(6):491–5. Available from: https://www.sciencedirect.com/science/article/pii/S0085253815524186
6. Nezhad ST, Sepaskhah R. Correlation of Clinical and Pathological Findings in Patients with Lupus Nephritis: A Five-Year Experience in Iran. Saudi J Kidney Dis Transplant [Internet]. 2008;19(1). Available from: https://journals.lww.com/sjkd/fulltext/2008/19010/correlation_of_clinical_and_pathological_findings.4.aspx
7. Anders H-J, Fogo AB. Immunopathology of lupus nephritis. Semin Immunopathol [Internet]. 2014;36(4):443–59. Available from: https://doi.org/10.1007/s00281-013-0413-5
8. Brugos B, Kiss E, Szodoray P, Szegedi G, Zeher M. Retrospective Analysis of Patients with Lupus Nephritis: Data From a Large Clinical Immunological Center in Hungary. Scand J Immunol [Internet]. 2006 Oct 1;64(4):433–7. Available from: https://doi.org/10.1111/j.1365-3083.2006.01833.x
9. Parichatikanond P, Francis ND, Malasit P, Laohapand T, Nimmannit S, Singchoovong L, et al. Lupus nephritis: clinicopathological study of 162 cases in Thailand. J Clin Pathol [Internet]. 1986 Feb 1;39(2):160 LP – 166. Available from: http://jcp.bmj.com/content/39/2/160.abstract
10. Hill GS, Delahousse M, Nochy D, Tomkiewicz E, Rémy P, Mignon F, et al. A new morphologic index for the evaluation of renal biopsies in lupus nephritis. Kidney Int [Internet]. 2000;58(3):1160–73. Available from: https://www.sciencedirect.com/science/article/pii/S0085253815472060
11. Najafi CC, Korbet SM, Lewis EJ, Schwartz MM, Reichlin M, Evans J. Significance of histologic patterns of glomerular injury upon long-term prognosis in severe lupus glomerulonephritis. Kidney Int [Internet]. 2001;59(6):2156–63. Available from: https://www.sciencedirect.com/science/article/pii/S0085253815477099
12. Hiramatsu N, Kuroiwa T, Ikeuchi H, Maeshima A, Kaneko Y, Hiromura K, et al. Revised classification of lupus nephritis is valuable in predicting renal outcome with an indication of the proportion of glomeruli affected by chronic lesions. Rheumatology [Internet]. 2008 May 1;47(5):702–7. Available from: https://doi.org/10.1093/rheumatology/ken019
13. Yong JLC, Killingsworth MC, Lai K. Renal biopsy pathology in a cohort of patients from southwest Sydney with clinically diagnosed systemic lupus erythematosus. Int J Nephrol Renovasc Dis [Internet]. 2013 Dec 31;6:15–26. Available from: https://www.tandfonline.com/doi/abs/10.2147/IJNRD.S34357
14. Satish S, Deka P, Shetty MS. A clinico-pathological study of lupus nephritis based on the International Society of Nephrology-Renal Pathology Society 2003 classification system. J Lab Physicians. 2017;9(03):149–55.
15. Schlesinger N, Schlesinger M, Seshan S V. Seasonal variation of lupus nephritis: High prevalence of class V lupus nephritis during the winter and spring. J Rheumatol. 2005;32(6):1053–7.
16. Sada K-E, Makino H. Usefulness of ISN/RPS Classification of Lupus Nephritis. jkms [Internet]. 2009 Jan 28;24(Suppl 1):S7–10. Available from: http://dx.doi.org/10.3346/jkms.2009.24.S1.S7
17. Karras A. Renal involvement in systemic lupus erythematosus. Press Medicale. 2012;41(3 PART 1):260–6.
18. Magil AB, Puterman ML, Ballon HS, Chan V, Lirenman DS, Rae A, et al. Prognostic factors in diffuse proliferative lupus glomerulonephritis. Kidney Int [Internet]. 1988;34(4):511–7. Available from: https://www.sciencedirect.com/science/article/pii/S0085253815343842
19. Austin HA, Muenz LR, Joyce KM, Antonovych TT, Balow JE. Diffuse proliferative lupus nephritis: Identification of specific pathologic features affecting renal outcome. Kidney Int [Internet]. 1984;25(4):689–95. Available from: https://www.sciencedirect.com/science/article/pii/S0085253815331847
20. MAGIL AB, BALLON HS, CHAN V, LIRENMAN DS, RAE A, SUTTON RAL. Diffuse Proliferative Lupus Glomerulonephritis: DETERMINATION OF PROGNOSTIC SIGNIFICANCE OF CLINICAL, LABORATORY AND PATHOLOGIC FACTORS. Medicine (Baltimore) [Internet]. 1984;63(4). Available from: https://journals.lww.com/md-journal/fulltext/1984/07000/diffuse_proliferative_lupus_glomerulonephritis_.3.aspx
21. Austin HA, Muenz LR, Joyce KM, Antonovych TA, Kullick ME, Klippel JH, et al. Prognostic factors in lupus nephritis: Contribution of renal histologic data. Am J Med [Internet]. 1983;75(3):382–91. Available from: https://www.sciencedirect.com/science/article/pii/0002934383903388
22. Hill GS, Delahousse M, Nochy D, Bariaty J. Class IV-S versus class IV-G lupus nephritis: Clinical and morphologic differences suggesting different pathogenesis. Kidney Int [Internet]. 2005;68(5):2288–97. Available from: https://www.sciencedirect.com/science/article/pii/S0085253815511253
23. Chedid A, Rossi GM, Peyronel F, Menez S, Atta MG, Bagnasco SM, et al. Low-Level Proteinuria in Systemic Lupus Erythematosus. Kidney Int reports. 2020 Dec;5(12):2333–40.
24. Touma Z. Proteinuria: Assessment and Utility in Lupus Nephritis. Orthop Res Physiother. 2016;2(1):1–8.
25. Gasparotto M, Gatto M, Binda V, Doria A, Moroni G. Lupus nephritis: clinical presentations and outcomes in the 21st century. Rheumatology (Oxford). 2020 Dec;59(Suppl5):v39–51.
26. Wang S, Spielman A, Ginsberg M, Petri M, Rovin BH, Buyon J, et al. Short- and Long-Term Progression of Kidney Involvement in Systemic Lupus Erythematosus Patients with Low-Grade Proteinuria. Clin J Am Soc Nephrol. 2022 Aug;17(8):1150–8.
27. Birmingham DJ, Rovin BH, Shidham G, Bissell M, Nagaraja HN, Hebert LA. Relationship between albuminuria and total proteinuria in systemic lupus erythematosus nephritis: diagnostic and therapeutic implications. Clin J Am Soc Nephrol. 2008 Jul;3(4):1028–33.
28. Kim Y-E, Ahn SM, Oh JS, Kim Y-G, Lee C-K, Yoo B, et al. Renal outcomes of transient proteinuria in patients with systemic lupus erythematosus treated with corticosteroid therapy alone. Lupus. 2022 May;31(6):716–22.
29. Mok CC, Teng YKO, Saxena R, Tanaka Y. Treatment of lupus nephritis: consensus, evidence and perspectives. Nat Rev Rheumatol [Internet]. 2023;19(4):227–38. Available from: https://doi.org/10.1038/s41584-023-00925-5
30. Braga FNHF, das Chagas Medeiros MM, Junior ABV, de Sousa Lima ME, Barros LCM, Pontes MX, et al. Proteinuria and serum creatinine after 12 months of treatment for lupus nephritis as predictors of long-term renal outcome: a case–control study. Adv Rheumatol [Internet]. 2022;62(1):2. Available from: https://doi.org/10.1186/s42358-021-00232-1
31. Lim CC, Tan HZ, Hao Y, Chin YM, Woo KT, Chan CM, et al. Long-term renal outcomes in multi-ethnic Southeast Asians with lupus nephritis: a retrospective cohort study. Intern Med J. 2018 Sep;48(9):1117–23.
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Muhammad Sajid Rafiq Abbasi
Assistant Professor, Department of Nephrology, Pakistan Institute of Medical Sciences Islamabad, Pakistan,
Khawar Sultan
Rawal Institute of Health Sciences, Islamabad, Pakistan
Naeemullah
Pakistan Institute of Medical Sciences Islamabad, Post Graduate Resident Nephrology, Islamabad, Pakistan
Adnan Mushtaq
Registrar Nephrology, Pakistan institute of Medical Sciences Islamabad, Pakistan,
Humayun Saleem
Public Health (MSPH), Health Services Academy, Islamabad, Pakistan,
Qudsia Umaira Khan
Associate Professor, Physiology, CMH Lahore Medical College
Maham Tariq
MBBS, Mohtarma Benazir Bhutto Shaheed Medical College Mirpur Azad Kashmir
Amna Akbar
Medical Officer AJK, University of Health Sciences Lahore, Pakistan
Sabahat Tasneem
Public Health Professional, MSPH, Health Services Academy, Islamabad, Pakistan
Sarosh Khan Jadoon
Resident Surgeon SKBZ/CMH Muzaffarabad AJK Pakistan,