Evaluation of visfatin in patients with systemic lupus erythematosus: Correlation with disease activity and lupus nephritis

Renal involvement affects about 50% of SLE patients accounting for significant morbidity and mortality in these patients. The adipokine "visfatin" acting as a growth factor for B-lymphocyte-precursors, exerts several proinflammatory functions. It was demonstrated as a marker of endothelial dysfunction [ED] in chronic kidney disease [CKD] thus could be a factor linking inflammation in SLE and kidney disease. To assess serum visfatin level in SLE patients and its correlation to disease activity and lupus nephritis [LN] in these patients. Serum level of visfatin using enzyme-linked immunosorbent assay [ELISA], chemical and immunological markers of SLE and LN were measured in 40 SLE patients and 40 age and sex matched healthy controls. Disease activity and renal involvement were assessed using SLE Disease Activity Index [SLEDAI] and Renal SLEDAI respectively further dividing patients into active versus inactive and LN versus non-LN respectively. Renal biopsies were taken from LN subgroup and were classified according to the modified WHO classification. A significantly higher serum visfatin level was found on comparing SLE patients [mean 109 +/- 180 ng/ml, median18] with controls [mean 9.4 +/- 11 ng/ml, median2.5] with statistically highly significant difference [z = 5.2, P < 0.001]. Also there was a statistically significant difference as regards serum visfatin level between active SLE patients [mean 173 +/- 111 ng/ml, median 14] and inactive patients [mean 139 +/- 88 ng/ml, median 5] [z = 2.1, P < 0.05] as well as between patients with LN [mean 226 +/- 180 ng/ml, median18] and patients with no LN [mean 101 +/- 140 ng/ml, median 8[2-229]] [z = 2.1, P < 0.05]. Visfatin had a highly significant positive correlation with disease duration [r = 0.48, P < 0.001], SLEDAI [r = 0.62, P < 0.001] as well as ESR, CRP and, renal score [r = 0.45, 0.35, and 0.65, respectively] while inverse correlation with estimated GFR [r = -0.614] and C3 and C4 titre [r = -0.26, r = -0.35, respectively] was recorded. Visfatin showed high sensitivity in detecting active SLE and LN 83% and 85%, respectively. Serum visfatin is strongly associated with LN in SLE patients and is a promising biomarker for prediction of renal involvement in these patients. It reflects SLE activity specially LN activity namely renal score and GFR decline. Further prospective studies are required to confirm visfatin as a destructive mediator of predictive and prognostic value in active lupus nephritis

Renal biopsy clinico-patho logical study in E.P.H. gestosis

Renal biopsy studies were performed on 15 cases of mild and severe E.P.H. gestosis in the department of Gynaecology and obstetrics, Ain Shams Univ. Hospitals, in the near post partum period. Light microscopic results for renal biopsies varied in severity with the clinical manifestations of the disease. Thickened glomerular basement membrane, enlargement of the glomeruli as well as increased lobulation was observed in severe cases. One case showed duplication of the basement membrane. The results of immunofluorescent studies in this work showed that plentiful IgM and to a lesser extent IgG deposits were always present within endothelial cells of glomerular loop and also in the mesangium. The deposits appeared granular and patchy in character. C[3] was seen in six of the cases examined. The deposits appeared proporational to the severity of the renal histopathological changes. C[3] deposition in the wall of afferent and efferent arterioles in this work did not correlate with the severity of the disease. Fibrin deposits were minimal or totally abscent in the examined specimens of this study. The correlation between the clinical degree of severity of E.P.H. condition, the light microscopic changes and the immunofluorescent appearances were confirmed

Coagulation and fibrinolytic activity in non-pregnant, normal pregnancy, mild and severe Pre-eclampsia

Sixty three pregnant females were involved in the present study; out of which 34 cases were normal uncomplicated pregnancy, 17 cases were mild pre-eclampsia and 12 cases were severe preeclampsia. In addition 12 non-pregnant healthy females were taken as controls. In both groups, the euglobulin lysis time [EGLT] was estimated as a measure of fibrinolytic activity, mainly the activators of plasminogen. Also platelet count, fibrinogen concentration, prothrombin activity, partial thromboplastin time, thrombin time, Antithrombin III [AT III] and fibrin degradation products [FDPS] were estimated. Results showed a significantly deminished fibrinolytic activity in spite of a high percentage positivity of FDPS. A chronic state of disseminated intravascular coagulation [DIG] is present in pre-eclampsia as evidenced by a high FDPS positivity, decreased AT. III, decreased platelet count and fibrinogen concentration decreased prothrombin activity, increased thrombin time and partial thromboplastin time. These findings are fully discussed

Benign mammary dysplasia among oral contraceptive users

A group of oral contraceptive users [46 cases] presenting with benign breast lumps which proved to be benign mammary dysplasia are investigated. The results are compared with another group of non-users [72 cases] having similar lesions. Cystic dysplastic lesions in form of simple ductal cysts and cystic ductal papillomatosis are commoner in the non-users than the oral contraceptive users. On the other hand, cysts with apocrine epithelium are more frequent in the later group. The non-cystic dysplasia in the form of lobular adenosis, fibresclerosis, benign epitheliosis and perilobular lymphocytic infiltration are more frequently encountered among the oral contraceptive uses