Change seen in histological pattern in patients with lupus nephritis with positive antiphospholipid serology

Background: it is debatable whether a repeat renal biopsy during lupus nephritis [LN] flare is helpful in guiding the treatment and predicting prognosis

Objective: to determine the value of serial renal biopsies in detecting histological changes in patients with lupus nephritis with APL antibodies

Study design, settings and Duration: this cross sectional retrospective study was conducted at King Saud University Medical City Riyadh, Kingdom of Saudi Arabia [KSA] during May 2013 to August 2017

Patients and Methods: patients having diagnosis of systemic lupus erythematosus [SLE] with positive APL antibodies and who underwent two or more renal biopsies for various indications were included into the study. The histological features of serial renal biopsies were compared. Renal biopsies were reassessed with light microscopy, immunofluorescence and electron microscopic studies and were categorized according to ISN/RPS 2004 classification. Data was analyzed using chi-square test to assess the differences between categorical study variables

Results: a total of 15 patients with LN having positive APL antibodies were included. The mean age of the patients was 38 +/- 10.5 years, and the disease duration was 160 +/- 9 months. The Interval between the two biopsies was 73.5 +/- 48 months. Antiphospholipid syndrome nephropathy [APSN] was noted in 4 [26%] patients at time of the first renal biopsy and in 9 [60%] on repeat biopsies. Thrombotic microangiopathy [TMA] which is the hallmark of APSN was detected in the repeat biopsy in two patients Change in the histological class was frequent and was seen in 12 out of the 15 patients while patients with proliferative LN class switching to non-proliferative class was rare

Conclusion: histological changes are common in serial biopsies in patients with lupus nephritis with positive APL serology. Repeat renal biopsies led to change in immunosuppression treatment in more than half of patients on average

Pulmonary manifestations of systemic lupus erythematosus patients with and without antiphospholipid syndrome

To uncover the pulmonary manifestations of Systemic Lupus Erythematosus [SLE] patients alone and to compare findings with antiphospholipid syndrome [APS] associated with SLE. This cross sectional comparative study was carried out at King Khalid University Hospital [KKUH]/King Saud University [KSU], a tertiary care hospital, Riyadh, Kingdom of Saudi Arabia. From June 2012 to March 2014, 96 diagnosed SLE patients with respiratory symptoms were included in the study and divided into two groups. Group one included SLE without antiphospholipid syndrome [APS] and group two SLE with APS. We compared Demographic features, clinical manifestations and findings of chest X-Ray, Arterial Blood Gases, Pulmonary function tests, six minute walk test, ventilation perfusion scan, echocardiography and chest high resolution computed tomography. Demographic and clinical characteristics of two groups were similar. Previous history of deep venous thrombosis [3% vs 27.6%, p=0.001], pulmonary embolism [3% vs34.5%, p<0.0001] and abortions [7.5% vs 27.6%, p=0.019] were significantly more in group two. Levels of Anticardiolipin antibody [0% vs 100%, p<0.0001] and lupus anticoagulant [1.5% vs 79.3%, p<0.0001] were also significantly higher in group two. Hypoxemia measured by pulse oximetry [43.3% vs 65.5% p=0.045, pulmonary Arterial Hypertension [15.5% vs 39.3% p=0.014]], and pulmonary embolism [3.4% vs 21.4% p=0.013] and ventilation perfusion mismatch on V/Q scan [1.5% vs 24.1% p=0.001] were more frequent in group two. Hypoxemia, pulmonary embolism and pulmonary arterial hypertension were significantly high in SLE patients with APS, requiring long term anticoagulation and treatment and close follow-up

Pattern of MRI brain in neuro-psychiatric SLE. effect of anti-phospholipid antibodies: a study at a tertiary care teaching hospital

To compare the neuro-radiologic findings in Systemic lupus erythematosus [SLE] patients with and without antiphospholipid antibodies [aPL] in different neuro-psychiatric manifestations. This cross-sectional comparative study was carried out at King Khalid University Hospital, a tertiary care teaching hospital, Riyadh, Saudi Arabia from June 2012 to January 2015. Ninety seven SLE patients with neuro-psychiatric manifestations were included in the study and divided into two groups. Group I [50 patients] SLE with aPL and group II [47 patients] SLE without aPL. We compared Demographic features, clinical manifestations and magnetic resonance imaging [MRI] brain findings. Demographic and clinical characteristics of two groups were similar. In Group-l, anticardiotipin antibodies [aCL] were most common [86%]. In patients with headache, most of the patients in Group-l had white matter hyperintensities [WMHIs] [50% vs 27%] while most of the patients in Group-ll had normal MRI brain [38% vs 73%]. Similarly WMHIs were found more in Group-l patients with seizures [60% vs 21%], while ischemia/infarction, atrophy and normal MRI were found in Group-ll. MRI brain in patients with neurological deficit and psychiatric disorder were not much different in both the groups. We found no statistically significant differences in frequencies of MRI brain abnormalities in SLE patients with and without aPL antibodies. Each of the three aPL may have a variable effect on the brain

Histological features of antiphospholipid nephropathy in patients with systemic lupus erythematosus

To determine the histological features of renal biopsies of Systemic Lupus Erythematosus [SLE] patients with and without antiphospholipid antibodies in Saudi population. Cross-sectional, comparative study. King Khalid University Hospital, Riyadh, Saudi Arabia, from January to December 2013. Consecutive SLE patients admitted to King Khalid University Hospital, Riyadh for renal biopsy for evaluation of proteinuria or deterioration of renal function were recruited. SLE patients with renal involvement were divided in two groups. Group one included patients with positive APS antibodies and group two included patients with negative APS antibodies. The histological features of renal biopsies of the two patients groups were compared. Data was analyzed using simple statistical analysis. The mean age of APS antibodies-positive patients was 30.37 +/- 10.714 years while mean age of APS negative patients was 33.62 +/- 11.717 years [p=0.224]. Twenty five [83.33%] patients were females and 5 [16.67%] patients were males in APS positive patients while 42 [89.36%] were females and 5 [10.63%] were males in group two. Acute lesions like thrombotic microangiopathy were in 2 [6.7%] of APS positive patients while chronic lesions like focal cortical atrophy was found in 6 [20%] and fibrous intimal hyperplasia was found in 9 [30%]. Other significant histological findings in APS antibodies positive group were glomerular basement membrane wrinkling in 12 [40%], glomerular double wall contour in 17 [56.7%], fibrous adhesions in 11 [36.7%] patients with APS antibodies. Systemic Lupus Erythematosus [SLE] patients with positive APS antibodies has specific histological findings suggesting an important role of APS antibodies in the pathogenesis of APS nephropathy

Pattern of MRI brain abnormalities in rheumatic patients with neurological involvement: a tertiary care teaching hospital experience

To explore the pattern of abnormalities seen on MRI in rheumatic patients with neurological manifestations and to interpret the findings in relation to clinical picture. Descriptive study. Rheumatology unit, King Khalid University Hospital, Riyadh, Saudi Arabia from January 2013 to February 2014. We prospectively included rheumatic patients with neurological symptoms and signs. The clinical data were correlated with MRI findings by a team comprising of a rheumatologist, neurologist and neuro-radiologist. Data was analyzed using simple statistical analysis. Fifty patients were recruited with a mean age of 36.4 +/- 10.76 years [range 17-62]. Among SLE patients with seizures, focal deficit and headache white matter hyperintensities were found in 9 [64.28%], 4 [50%], 4 [80%] patients respectively. Out of seven SLE patients with global dysfunction, 3 [42.85%] had brain atrophy and 2 [28.57%] normal MRI. In Behcet's disease with focal deficit, 3 [75%] patients had white matter hyperintensities and 1 [25%] had brainstem involvement. In Behcet's disease with headache, 2 [50%] had normal MRI, 1 [25%] brainstem hyper-intensities and 1 [25%] had subacute infarct. Two [66%] of three Primary APS patients had white matter hyperintensities while third [33%] had old infarct. Both patients of polyarteritisnodosa, had white matter hyperintensities. Out of two Wegener's granulomatosis one had white matter hyperintensities and other had ischemic changes in optic nerves. The only one scleroderma patient had white matter hyperintensities. We found that white matter hyperintensities was the most common MRI abnormality in our study group which in most of the cases had poor clinical correlation. No distinct pattern of CNS involvement on MRI was observed in various rheumatic disorders