Anti-C1q como Marcador de Nefritis Lúpica / Anti-C1q as Lupus Nephritis Marker

Introducción: Los autoanticuerpos anti-C1q han sido propuestos como un marcador útil en el lupus eritematoso sistémico por su asociación con la nefritis lúpica. Objetivo: Determinar la prevalencia de anti-C1q en pacientes con lupus eritematoso sistémico y otras enfermedades reumáticas para la evaluar la asociación con la nefropatía lúpica. Métodos: Se incluyeron 179 pacientes con lupus eritematoso sistémico y 82 con otras enfermedades reumáticas. La nefritis lúpica fue diagnosticada en 70 (39 por ciento) de los pacientes con lupus eritematoso sistémico. Los anticuerpos anti-C1q IgG se determinaron por ELISA. Las asociaciones se evaluaron por análisis de regresión logística. Resultados: La prevalencia de anti-C1q fue de 37 poe ciento (66/179) en los pacientes con lupus eritematoso sistémico y de 9 por ciento (7/82) en controles (OR = 6,3; IC 95 por ciento 2,8-14,1; p < 0,001). El anti-C1q fue asociado con proteinuria (OR = 2,6; IC 95 por ciento 1,2-6,0; p < 0,022); eritrosedimentación elevada (OR = 3,2; IC 95 por ciento 1,5-6,7; p < 0,003) y anti-DNAdc (OR = 3,9; IC 95 por ciento 1,7-9,1; p < 0,002). En el modelo de regresión logística ajustado para demografía y anti-DNAdc, aunque la OR del anti-C1q para la nefritis fue 2 veces más alta que en ausencia del anti-C1q, solo se aproximó a la significación estadística. La positividad simultánea de anti-C1q y anti-DNAdc estuvo asociada a la nefritis lúpica (OR = 4,3; IC 95 por ciento 1,9-9,5; p < 0,001). Conclusiones: El anti-C1q se presentó con mayor frecuencia en pacientes con lupus eritematoso sistémico que en los controles. El anti-C1q combinado con anti-DNAdc resultó fuertemente asociado a la nefritis lúpica(AU)

Introducción: Anti-C1q autoantibodies have been proposed as useful marker in systemic lupus erythematosus due to their association with lupus nephritis. Objective: To determine the prevalence of anti-C1q in patients with systemic lupus erythematosus and other rheumatic diseases to evaluate the association with lupus nephropathy. Methods: One hundred seventy-nine patients with systemic lupus erythematosus and 82 with other rheumatic diseases were included. Lupus nephritis was diagnosed in 70 (39percent) of patients with systemic lupus erythematosus. Anti-C1q IgG antibodies were determined by ELISA. Associations were evaluated by logistic regression analysis. Results: The prevalence of anti-C1q was 37percent (66/179) in patients with systemic lupus erythematosus and 9percent (7/82) in controls (OR = 6.3; 95percent CI 2.8-14). .1; p < 0.001). Anti-C1q was associated with proteinuria (OR = 2.6; 95percent CI 1.2-6.0; p < 0.022); elevated erythrocyte sedimentation rate (OR = 3.2; 95percent CI 1.5-6.7; p < 0.003) and anti-dsDNA (OR = 3.9; 95percent CI 1.7-9.1; p < 0.002). In the logistic regression model adjusted for demographics and anti-dsDNA, although the OR of anti-C1q for nephritis was 2-fold higher than in the absence of anti-C1q, it only approached statistical significance. Simultaneous positivity of anti-C1q and anti-dsDNA was associated with lupus nephritis (OR = 4.3; 95percent CI 1.9-9.5; p < 0.001). Conclusions: Anti-C1q occurred more frequently in patients with systemic lupus erythematosus than in controls. Anti-C1q combined with anti-dsDNA was strongly associated with lupus nephritis(AU)

Risk factors of childhood systemic lupus erythematosus with thyroid dysfunction / 中华儿科杂志

Objective: To investigate the risk factors of childhood systemic lupus erythematosus (SLE) with thyroid dysfunction and to explore the relationship between thyroid hormone and kidney injury of lupus nephritis (LN). Methods: In this retrospective study, 253 patients who were diagnosed with childhood SLE and hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2021 were enrolled in the case group, and 70 healthy children were the control cases. The patients in the case group were divided into the normal thyroid group and the thyroid dysfunction group. Independent t-test, χ2 test, and Mann-Whitney U test were used for comparison between the groups, Logistic regression analysis was used for multivariate analysis, and Spearman correlation. Results: A total of 253 patients, there were 44 males and 209 females in the case group, and the age of onset was 14 (12, 16) years; a total of 70 patients, 24 males and 46 females were in the control group, and the age of onset was 13 (10, 13) years. The incidence of thyroid dysfunction in the case group was higher than that in the control group (48.2% (122/253) vs. 8.6% (6/70), χ²=36.03, P<0.05). Of the 131 patients, there were 17 males and 114 females in the normal thyroid group, and the age of onset was 14 (12, 16) years. Of the 122 patients in the thyroid dysfunction group, 28 males and 94 females were in the thyroid dysfunction group, and the age of onset was 14 (12, 16) years. Of the 122 had thyroid dysfunction, including 51 cases (41.8%) with euthyroid sick syndrome, 25 cases (20.5%) with subclinical hypothyroidism, 18 cases (14.8%) patients with sub-hyperthyroidism, 12 cases (9.8%) with hypothyroidism, 10 cases (8.2%) with Hashimoto's thyroiditis, 4 cases (3.3%) with hyperthyroidism, and 2 cases (1.6%) with Graves disease. Compared to patients with normal thyroid function, the serum level of triglyceride, total cholesterol, urine white blood cell, urine red blood cell, 24 h urine protein, D-dimer, and fibrinogen, ferritin and systemic lupus erythematosus disease activity Index-2000 (SLEDAI-2K) score were higher in patients with thyroid dysfunction (Z=3.07, 3.07, 2.48, 3.16, 2.40, 3.99, 2.68, 2.55, 2.80, all P<0.05), while the serum level of free thyroxine and C3 were lower in thyroid disfunction patients (10.6 (9.1, 12.7) vs. 11.3 (10.0, 12.9) pmol/L, and 0.46 (0.27, 0.74) vs. 0.57 (0.37, 0.82) g/L, Z=2.18, 2.42, both P<0.05). The higher level of triglyceride and D-dimer were the independent risk factors for childhood SLE with thyroid dysfunction (OR=1.40 and 1.35, 95%CI 1.03-1.89 and 1.00-1.81, respectively, both P<0.05). There were 161 patients with LN in the case group, all of which were conducted with renal biopsies, including 11 cases (6.8%) with types Ⅰ LN, 11 cases (6.8%) with typesⅡLN, 31 cases (19.3%) with types Ⅲ LN, 92 cases (57.1%) with types Ⅳ LN, and 16 cases (9.9%) with types Ⅴ LN. There were significant differences in the level of free triiodothyronine and thyroid stimulating hormone among different types of kidney pathology (both P<0.05); compared with types I LN, the serum level of free triiodothyronine was lower in types Ⅳ LN (3.4 (2.8, 3.9) vs. 4.3 (3.7, 5.5) pmol/L, Z=3.75, P<0.05). The serum level of free triiodothyronine was negatively correlated with the acute activity index score of lupus nephritis (r=-0.228, P<0.05), while the serum level of thyroid stimulating hormone was positively correlated with the renal pathological acute activity index score of lupus nephritis (r=0.257, P<0.05). Conclusions: There is a high incidence of thyroid dysfunction in childhood SLE patients. The higher SLEDAI and more severe renal damage were found in SLE patients with thyroid dysfunction compared to these with normal thyroid functions. The risk factors of childhood SLE with thyroid dysfunction are the higher level of triglyceride and D-dimer. The serum level of thyroid hormone is possibly related to the kidney injury of LN.

Pediatric lupus nephritis / Nefrite lúpica em pediatria

Abstract Involvement of the kidneys by lupus nephritis (LN) is one of the most severe clinical manifestations seen in individuals with systemic lupus erythematosus (SLE). LN is more frequent and severe in pediatric patients and has been associated with higher morbidity and mortality rates. This narrative review aimed to describe the general aspects of LN and its particularities when affecting children and adolescents, while focusing on the disease's etiopathogenesis, clinical manifestations, renal tissue alterations, and treatment options.

Resumo A nefrite lúpica (NL) é caracterizada pelo acometimento dos rins no contexto das diversas manifestações clínicas do Lupus Eritematoso Sistêmico (LES), e representa uma das manifestações clínicas mais graves da doença. A NL é mais frequente e mais grave nos pacientes pediátricos, em comparação com os adultos, e causa maiores taxas de morbidade e mortalidade. O objetivo desta revisão narrativa foi descrever os aspectos gerais da NL e suas particularidades em crianças e adolescentes, com foco em sua etiopatogênese, nas manifestações clínicas, nas alterações histopatológicas renais e na abordagem terapêutica.

Características sociodemográficas y clínicas de pacientes con nefritis lúpica. Barranquilla, Colombia / Sociodemographic and clinical characteristics of patients with lupus nephritis. Barranquilla, Colombia

La Nefritis Lúpica (NL) es una complicación relevante del paciente con lupus eritematoso sistémico (LES). Las condiciones socio demográficas pueden ser vulnerables a la aparición de la enfermedad?. Estudio cuantitativo, descriptivo y transversal. Población conformada por 22 pacientes con (NL) del programa de Nefrored del Caribe que asistieron a una institución prestadora de salud en la ciudad de Barranquilla, de enero de 2017 a enero de 2018. La muestra fue por conveniencia. La información se realizó a través de instrumento tipo escala de Likert, conformada por las variables: características socio demográficas (sexo, ubicación geográfica, estado civil), tiempo de diagnóstico de la enfermedad y toma del medicamento ordenado. El 96% era de sexo femenino y el 4% de sexo masculino, 27.3% estuvo entre edades de 34 y 45 años, el 54.5% era procedente de la ciudad de Barranquilla, y el 2.7% de los pacientes tenìan diagnóstico en un plazo de tiempo menor a los 2 años de haber presentado manifestaciones clínicas. Las condiciones sociodemograficas y clinicas de los pacientes con LES que desarrollan NL permitirán desarrollar acciones para un diagnóstico oportuno e intervención efectiva que coadyuven a la adherencia al tratamiento, y a reducir la morbilidad en los pacientes de la Region Caribe Colombiana(AU)

Lupus Nephritis (LN) is a significant complication of the patient with systemic lupus erythematosus (SLE). Socio-demographic conditions may be vulnerable to the onset of the disease. This was a quantitative analytical and transversal study. Population comprised 22 patients with LN of the Renal Network of the Caribbean program attending a health care institution in the city of Barranquilla from January 2017 to January 2018. The sample was for convenience. The information was collected using a Likert scale instrument including these variables: socio-demographic characteristics (sex, geographical location, marital status), time of diagnosis of the disease, intake of medical prescription medicine. Ninety six percent was female and 4% male, 27.3% was between the ages of 34 and 45 years, 54.5% was from the city of Barranquilla, and 2.7% patients were diagnosed in a period of time lower than 2 years of having presented clinical manifestations. The socio-demographic and clinical conditions of patients with SLE that developed NL will allow developing actions for a timely diagnosis and effective intervention for better adherence to treatment, and reduce the morbidity associated with socio-demographic conditions that may influence patients in the Colombian Caribbean Region(AU)

Mild and moderate Mannose Binding Lectin deficiency are associated with systemic lupus erythematosus and lupus nephritis in Brazilian patients / As deficiências leve e moderada de lectina ligadora de manose estão associadas ao lúpus eritematoso sistêmico e à nefrite lúpica em pacientes brasileiros

Abstract Objective The potential association of mannose binding lectin (MBL) deficiency and systemic lupus erythematosus (SLE) has been investigated in several studies, but results have been mixed. One explanation for the conflicting results could be differences in ethnic background of study subjects. In this study we investigated the association of MBL deficiency and SLE in a large cohort of Brazilian SLE patients and controls. Methods Serum MBL and Complement levels were determined for 286 Brazilian adult SLE patients and 301 healthy Brazilian adults as controls. MBL deficiency was classified as mild (<1000 and ≥500 µg/L), moderate (<500 and ≥100 µg/L) or severe (<100 µg/L). Results SLE patients presented higher frequency of mild and moderate MBL deficiency compared to controls. SLE patients with MBL deficiency presented higher frequency of lupus nephritis compared to those without MBL deficiency. MBL deficiency was not associated with any other clinical manifestation, use of immunosuppressant therapy, disease activity, disease severity serum or Complement levels. Conclusion This study shows that an association between MBL deficiency and SLE does exist in the Brazilian population. We also found an association between MBL deficiency and lupus nephritis. These findings support the hypothesis that MBL deficiency contributes to the development of SLE and lupus nephritis.

Resumo Objetivo Vários estudos já investigaram a potencial associação entre a deficiência de lectina de ligação a manose (LLM) e o lúpus eritematoso sistêmico (LES), mas os resultados obtidos são controversos. Uma explicação para esses resultados conflitantes poderia estar nas diferenças étnicas dos indivíduos estudados. Este estudo investigou a associação entre a deficiência de LLM e o LES em uma grande coorte de pacientes brasileiros com LES e controles. Métodos Determinaram-se os níveis séricos de LLM e complemento em 286 pacientes adultos brasileiros com LES e 301 adultos brasileiros saudáveis que atuaram como controles. A deficiência de LLM foi classificada como leve (< 1000 e ≥ 500 µg/L), moderada (< 500 e ≥ 100 µg/L) ou grave (< 100 µg/L). Resultados Os pacientes com LES apresentaram maior frequência de deficiências leve e moderada de LLM em relação aos controles. Os pacientes com LES com deficiência de LLM apresentaram maior frequência de nefrite lúpica em comparação com aqueles sem deficiência de LLM. A deficiência de LLM não esteve associada a qualquer outra manifestação clínica, uso de terapia imunossupressora, atividade da doença, gravidade da doença ou níveis séricos de complemento. Conclusão Este estudo mostra que há uma associação entre a deficiência de LLM e o LES na população brasileira. Encontrou-se também uma associação entre a deficiência de LLM e a nefrite lúpica. Esses resultados apoiam a hipótese de que a deficiência de LLM contribui para o desenvolvimento do LES e da nefrite lúpica.

Profile of glomerular diseases in a public hospital of Federal District, Brazil / Perfil das doenças glomerulares em um hospital público do Distrito Federal

INTRODUÇÃO: As doenças glomerulares são uma causa frequente de doença renal crônica, sobretudo nos países em desenvolvimento. OBJETIVO: O objetivo deste estudo foi determinar o perfil destas glomerulopatias em um hospital público da cidade de Brasília, Distrito Federal. MÉTODOS: Foram realizadas 121 biopsias renais pela equipe de nefrologia do Hospital Regional da Asa Norte (HRAN) entre agosto de 2005 e maio de 2009. Foram excluídas oito biopsias realizadas em pacientes transplantados renais e analisados os prontuários dos 113 pacientes restantes. Dados analisados: sexo, idade, exames laboratoriais, síndrome glomerular, diagnóstico clínico, grau de fibrose intersticial, uso de imunossupressores, necessidade de diálise e desfecho clínico. RESULTADOS: A média de idade foi 34,9 ± 16,2 anos, com predomínio masculino (51,3 por cento). As principais síndromes glomerulares foram: síndrome nefrótica (41,6 por cento) e glomerulonefrite rapidamente progressiva (35,4 por cento). Entre as glomerulopatias primárias, houve predomínio da glomeruloesclerose segmentar e focal (26,9 por cento) e da nefropatia por IgA (25 por cento) e entre as secundárias a nefrite lúpica (50 por cento) e a glomerulonefrite proliferativa exsudativa difusa (34,2 por cento). A maioria dos pacientes fez uso de imunossupressores (68,1 por cento) e quase um terço deles (29,2 por cento) necessitou de diálise durante a internação. Evoluíram para terapia dialítica crônica 13,3 por cento dos pacientes e 10,6 por cento evoluíram a óbito. CONCLUSÃO: Este estudo poderá contribuir para melhor entendimento epidemiológico das doenças glomerulares no Distrito Federal, orientando na adoção de políticas públicas visando permitir rápido diagnóstico e manejo clínico das mesmas.

INTRODUCTION: Glomerular diseases are a frequent etiology of chronic kidney disease, especially in the developing countries. OBJECTIVE: To determine the profile of such glomerulopathies in a public hospital located in the city of Brasilia, Federal District. METHODS: 121 renal biopsies in different patients were performed by the Renal Division of Hospital Regional da Asa Norte (HRAN) between August 2005 and May 2009. Eight renal biopsies in renal-transplant patients were excluded and the medical records of 113 remaining patients were analyzed. Analyzed data: sex, age, laboratory exams, glomerular syndrome, clinical diagnosis, degree of interstitial fibrosis, immunosuppressants use, need for dialysis and clinical outcome. RESULTS: The age average was 34.9 ± 16.2 years-old, a predominance of male patients (51.3 percent). Major glomerular syndromes were: nephrotic syndrome (41.6 percent) and the rapidly- progressive glomerulonephritis (35.4 percent). Among primary glomerulopathies focal glomerulosclerosis (26.8 percent) followed by IgA nephropathy (25 percent) were predominant; and among the most prevalent secondary glomerulopathies we had lupus nephritis (50 percent) and diffuse exudative proliferative glomerulonephritis (34.2 percent).The majority of the patients used immunosuppressants (68.1 percent) and almost one third of them (29.2 percent) needed dialysis during their hospitalization. Progressed to chronic dialysis therapy 13.3 percent of the patients and 10.6 percent died. CONCLUSION: This study may contribute to better epidemiological understanding of glomerular diseases in the Federal District, guiding the adoption of public policies aiming the quick clinical treatment of such diseases.

Histopathological pattern in childhood glomerulonephritis

To determine the histopathological pattern in childhood glomerulonephritis [CGN]. This retrospective analysis of renal biopsies of 118 children with various clinical syndromes of CGN was carried out at the National Institute of Child Health [NICH] and The Kidney Center [TKC], Karachi, from July 2005 to December 2009. The age ranged from 6 months to 16 years. All biopsies were studied under light microscopy [LM] and immunoflourescence [IMF] Histopathological lesions [HPL] were classified as primary and secondary glomerular diseases. Demographic data, indications and HPL were retrieved and analyzed using descriptive statistics. Out of 118 patients, 62 [52.54%] were males and 56[47.45%] females. Mean age was 8.2 +/- 3.9 years. Major indications for biopsy were primary nephrotic syndrome [PNS 86, 72.88%]. secondary GN [SGN, 17, 14.4%] and nephritic-nephrotic syndrome [NNS 13, 11%]. Overall, primary glomerular diseases [PGD] accounted for 84.74% of all biopsies. Minimal change disease [MCD 38, 32.2%] and focal segmental glomerulosclerosis [FSGS 35, 29.66%] were the two most common lesions and accounted for 43% and 33.72% respectively in PNS. Other important lesions were membranous GN [MGN 10, 8.47%], membranoproliferative [MPGN 9, 7.16%], post-infective [PIGN 4, 3.38%] and IgM nephropathy [IgMN 3, 2.54%]. Among secondary glomerular diseases [SGD], lupus nephritis [LN 11, 9.32%] was the most common lesion followed by Henoch-Schonlein nephritis [HSN] and haemolytic uraemic syndrome [HUS] each in 3 [2.52%]. Overall, MCD and FSGS were the two most common HPL in PGD and both dominated in PNS. Lupus nephritis was the leading lesion in SGD. These histopathological pattern of CGN in our study is in conformity with the existing literature from Pakistan

Spectrum of glomerular diseases at King Hussein medical center

To determine the histopathological patterns of glomerulonephritis according to the clinical presentation. This is a retrospective analysis of light microscopy results of native kidney biopsies done during the period of January 1[st], 2005 until December 31[st], 2008. There were 273 native kidney biopsies performed during this period. Data were collected from the computer data base of Princess Iman Research and Laboratory Center, King Hussein Medical Center, Amman, Jordan. All biopsies were examined by our renal histopathologist. The most common indication was nephrotic syndrome and the most common cause of nephrotic syndrome in our patients was membranous glomerulonephritis. The main cause of subnephrotic proteinuria was minimal change disease and focal and segmental glomerulosclerosis. Membranoproliferative glomerulonephritis was the most frequent finding in patients presenting with microscopic hematuria. In acute nephritis the most common lesions were crescentic, diffuse proliferative and necrotizing glomerulonephritis. Acute tubular necrosis was the most common cause of acute kidney injury. Changes of end stage kidney disease were the most frequent findings in patient with chronic kidney disease. In patients with systemic lupus erythematosus with renal involvement, the most common lesion was class IV lupus nephritis. Kidney biopsy is an extremely helpful investigation and it should be performed once indicated. There is a need for a national registry of kidney biopsies. The histopathological findings are similar to other studies done in Jordan and in the neighboring countries

Associação entre anticorpos antifosfolípides e fator reumatóide empacientes com nefrite lúpica: um estudo de 187 casos / Associatiom between antiphospholipid antibodies and rheumatoid factor in patients with Lupus Nephrits: a study of 187 cases

Introdução: Nefrite é uma manifestação freqüente no lúpus eritematoso sistêmico (LES), tendo uma prevalência de 40 a 75%. Embora esteja associada com a ocorrência de anticorpo anti-DNA, outros autoanticorpos podem estar ligados ao seu aparecimento taiscomo o fator reumatóide (FR) e os anticorpos antifospholípides (aPl).Objetivos: verificar a prevalência de nefrite lúpica local e sua associação com o a presença do FR e aPls. Métodos: Revisaram-se 187 prontuários depacientes com LES para presença de nefrite, FR e aPl . Resultados: Encontrou-se uma prevalência de 35,3% de glomerulonefrite. Houve correlação negativa entre nefrite e FR (p=0.001). Não se encontrou associação entre aparecimento de aPl e nefrite, já queo número de pacientes com glomerulonefrite que apresentaram esses testes positivos foram de 8 (32%)em 59; 5 (27,7%) em 58 e 6 (46,1%) em 29, respectivamente. Conclusão: Existe uma prevalência de 35% denefrite na população local de LES a qual tem uma associação negativa com aparecimento do FR. Presença de aPls não influíram no aparecimento da nefrite lúpica.

Summary: Nephritis is a frequent manifestation of systemic lupus erythematosus (SLE), with an averageof 40 to 75%. It’s associated with the presence of anti-DNA antibodies;other antibodies may also be involved,such as rheumatoid factor (RF), and antiphospholipid antibodies (aPl).Objectives: to verify the prevalence of lupus nephritis and its association with RF and aPl antibodies. Methods: The charts of 187 patients with SLE werereviewed for the presence of nephritis, RF and aPl. Results: A prevalence of 35.3% of nephritis was found. There was a negative correlation betweennephritis and presence of rheumatoid factor (p=0,001). No association between the presence of aPl and nephritis was found, since the number of patients with glomerulonephritis that were positive for these tests wasof 8 (32%) in 59, 5 (27,77%) in 58 and 6 (46,1%) in 29, respectively.Conclusion: There is a prevalence ofglomerulonephritis of 35% in the local SLE population, which has a negative association with rheumatoid factorpresence. Antiphospholipid antibodies aren’t associated to the occurrence of lupus nephritis.

Renal histological findings in adults in Jamaica / Hallazgos histológicos renales en adultos en Jamaica

BACKGROUND: In 2006, it was reported that Focal and Segmental Glomerulosclerosis (FSGS), Minimal Change Disease (MCD) and Membranous Glomerulonephritis (MGN) were the commonest primary glomerular diseases identified from percutaneous kidney biopsies done in Jamaica for that year (n = 76). The sample size was thought to be small and might have affected the reported findings. So a threeyear review of percutaneous kidney biopsies in Jamaica was carried out. METHODS: Histology reports and clinical data were reviewed for percutaneous kidney biopsies performed from January 2005 to December 2007. Demographic data (age, gender), laboratory investigations such as serum urea, serum creatinine, proteinuria, haematuria, 24-hour urinary protein, and creatinine clearance, and clinical diagnosis were collected from the histology requisition form. RESULTS: There was a total of 224 native kidney biopsies performed. There were 91 males (40.6%) and 133 females (59.4%). Age distribution showed a total number of 25 paediatric cases (11.2%) and 199 adult cases (88.8%). Proteinuria was present in 171 cases (76.3%) and haematuria in 86 cases (38.4%). Of the total biopsies done, 78 cases (39.2%) had primary glomerular diseases, 110 cases (55.3%) had secondary glomerular diseases and 11 (5.5%) biopsies were reported as either normal or inadequate for histological diagnosis. The most common reasons indicated for percutaneous kidney biopsy were proteinuria, haematuria and staging of lupus nephritis. Most common histological findings for primary glomerular disease after percutaneous kidney biopsy were FSGS (n = 34), MGN (n = 15) and MCD (n = 12). In secondary glomerular diseases (n = 110), there were more females (70.8%) than males. Systemic lupus erythematosus was present in 63.3%. Histology of lupus nephritis according to the International Society of Nephrologists classification shows Membranous Lupus Nephritis [MLN] (40.2%), Diffuse Lupus Nephritis [DLN] (19.5%) and Minimal Mesangial Lupus Nephritis [MMLN] (14.3%) as the common histological types. CONCLUSIONS: The most common histological finding for primary glomerular disease following percutaneous kidney biopsy was FSGS, MCD and MGN. Membranous Lupus Nephritis was the commonest histological type for lupus nephritis in this series.

ANTECEDENTES: En 2006, se reportó que la Glomeruloesclerosis Segmentaria y Focal (GESF), la Enfermedad de Cambios Mínimos (ECM) y la Glomerulonefritis Membranosa (GNM) fueron las enfermedades glomerulares primarias más comunes identificadas a partir de las biopsias renales percutáneas realizadas en Jamaica ese año (n = 76). El tamaño de la muestra se consideró pequeño y pudo haber afectado los hallazgos reportados. De manera que se realizó un examen de tres años, de las biopsias renales percutáneas en Jamaica. MÉTODOS: Se revisaron los reportes de histología y los datos clínicos correspondientes a las biopsias renales percutáneas realizadas desde enero de 2005 a diciembre de 2007. RESULTADOS: Hubo un total de 224 biopsias de riñón nativo. Se realizaron 74, 78 y 72 biopsias renales en 2005, 2006 y 2007 respectivamente. Hubo 91 varones (40.6%) y 133 hembras (59.4%). La distribución por edades mostró un total de 25 casos pediátricos (11.2%) y 119 casos de adultos (88.8%). La proteinuria estuvo presente en 171 casos (76.3%) y la hematuria en 86 casos (38.4%). Del total de biopsias realizadas, 78 casos (39.2%) tenían enfermedades glomerulares primarias, 110 casos (55.3%) tenían enfermedades glomerulares secundarias y 11 (5.5%) biopsias fueron reportadas como normales, o como inadecuadas para el diagnóstico histológico. Las razones más comunes señaladas para la biopsia renal percutánea fueron la proteinuria, la hematuria y la estadificación de la nefritis por lupuso nefritis lúpica. Los hallazgos histológicos más comunes para la enfermedad glomerular primaria tras la biopsia renal percutánea fueron GESF (n = 34), GNM (n = 15) y ECM (n = 12). En relación con las enfermedades glomerulares secundarias (n = 110), hubo más hembras (70.8%) que varones. El lupus eritematoso sistémico estuvo presente en 63.3%. De acuerdo con la clasificación de la Sociedad Internacional de Nefrología, la histología de la nefritis por lupus muestra la nefritis lúpica membranosa (NLM) [40.2%], la nefritis lúpica difusa (NLD) [19.5%], y la nefritis lúpica mesangial mínima (NLMM) [14.3%], como los tipos histológicos más comunes. CONCLUSIÓN: Los hallazgos histológicos más comunes para la enfermedad glomerular primaria tras la biopsia renal percutánea, fueron GESF, ECM y GNM. La nefritis lúpica membranosa fue el tipo de histología más común para la nefritis por lupus en esta serie.

Nefritis Lúpica: Factores asociados y pronósticos en una población multiétnica / Lupus nephritis: Associate factors and forecasts in a multiethnic population

El compromiso renal es reconocido como una de las complicaciones más serias en el LES y es uno de los factores más importantes de mal pronóstico. Numerosos estudios epidemiológicos en pacientes con NL han sido publicados y más de trece factores de riesgos independientes predictores de progresión han sido identificados. En este trabajo estudiamos los factores demográficos e inmunológicos asociados con el desarrollo de NL en una población multiétnica y analizamos los diferentes factores que afectan el pronóstico de la NL con énfasis en el rol de los AAF y las diferentes clases histopatológicas de NL.Se evaluaron retrospectivamente 156 pacientes que cumplían con los criterios de LES acorde al ACR (182), con biopsia renal compatible con el diagnóstico de NL atendidos en la unidad de Lupus del hospital St. Thomas ‘s de la ciudad de Londres y en la unidad de reumatología del hospital Córdoba de la ciudad de Córdoba en los últimos 12 años. 110 pacientes fueron estudiados en la unidad de lupus del hospital St. Thomas ´s y 47 pacientes fueron incluídos en la unidad de reumatología del hospital Córdoba.Los datos demográficos, presentación clínica, laboratorio y tratamiento fueron recolectados de las historias clínicas al momento de la biopsia renal. Las biopsias renales fueron clasificadas acuerdo a los criterios de clasificación de la glomerulonefritis lúpica ISN/RPS 2004 (433). Los índices de actividad y cronicidad fueron estimados acorde al sistema modificado por Austin (19). Las lesiones histopatológicas sugestivas de NSAF fueron evaluadas por los patólogos ciegos de los datos clínicos. El pronóstico renal fue evaluado por el desarrollo de insuficiencia renal crónica definida por la duplicación del nivel de creatinina sobre el valor basal, el desarrollo de enfermedad renal terminal definida por la necesidad de diálisis o trasplante renal, y muerte. El filtrado glomerular fue medido por EDTA-GFR.

Non-neoplastic renal diseases in Kerala, India--analysis of 1592 cases, a two year retrospective study.

A retrospective analysis of 1592 renal biopsies received from various hospitals all over Kerala over a period of two years was done. Of the 1544 native kidney biopsies majority of cases (300; 18.84%) were focal segmental glomerulosclerosis. Next infrequency was IgA nephropathy (227; 14.26%). The other diagnoses included post infectious glomerulonephritis (GN) (150; 9.42%), lupus nephritis (131; 8.23%), membranous glomerulonephritis (118; 7.41%), minimal change disease (94; 5.94%), interstitial nephritis 87(5.46%), membranoproliferative glomerulonephritis (MPGN) and severe glomerulosclerosis (74; 4.64% each), IgM nephropathy (72; 4.52%), acute tubular necrosis and diabetic glomerulopathy (24; 1.5% each), ANCA-related GN (21;1.32%), amyloidosis (13; 0.82%), Henoch Schonlien purpura (12; 0.75%) atd thrombotic microangiopathy (10; 0.63%). Afew others like myeloma cast nephropathy, cholesterol embolism, Clq nephropathy, oxalosis, mixed connective tissue disorder (MCTD, Wegner's granulomatosis etc. also were seen occasionally. 48 cases were allograft biopsies (3.02%).

Renal Involvement in Systemic Lupus Erythematosus in Pakistan

To find the prevalence of lupus nephritis, delineate its clinical, immunological and therapeutic characteristics and compare them with the data worldwide. Between 1985 and 2001, 198 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association [ARA] admitted to the hospital were studied by means of a retrospective review of their records. Renal involvement was found in 89 [45%] patients. Biopsy showed lupus nephritis in 42 patients; there were 9 male and 33 females. Mean age at initial presentation was 27 years and mean duration of follow-up was 2.3 years. The histological types [WHO Classification] were mainly class. 4 [n=27], class 3 [n=7] and class 5 [n=6]. Immunoflourescence showed a predominantly granular pattern of IgG, IgA and C3. Renal manifestations included renal failure [50%], microscopic hematuria [67%], active urine sediment [22%], and proteinuria [74%]. Proteinuria was nephrotic range in 45% patients. Treatment was with combinations of prednisolone and cyclophosphamide [n=13], prednisolone and azathioprine [n=27]. 19 patients received high dose methyl prednisolone [1 gm/day for 3 days]. There was no difference in mortality rate between prednisolone and cyclophosphamide and prednisolone and azathioprine treatment groups. The overall mortality rate was 17% [n=7]. Mortality was higher in WHO class 4 and 5 as compared to class 2 and 3 [p<0.001]. The prevalence of lupus nephritis in our population is an intermediate between Caucasians and other Asians. Certain clinical characteristics in our patients with lupus nephritis are different as compared to various other studies. Because of limited resources for treatment in developing countries, we believe that patients with lupus nephritis should be treated with improved ancillary medical therapies and more effective immunosuppressive regimens

Análise da sobrevida em pacientes com lúpus eritematoso sistêmico / The survival analysis in patients with systemic lupus erythematosis

Analisa os fatores de risco para a mortalidade, bem como para a perda da funçäo renal, em uma coorte de pacientes com lúpus eritematoso sistêmico (LES). Uma coorte de 253 pacientes foi acompanhada em um hospital público do Município de Säo Paulo, por um período de 17 anos (1978-1995), de acordo com protocolo padronizado. Foram realizadas duas análises de sobrevida: a primeira foi a análise até o óbito e, a segunda, a análise da sobrevida até o surgimento da insuficiência renal terminal. As variáveis independentes foram as características demográficas desses pacientes, bem como as alteraçöes clínicas e laboratoriais mais comumente relacionadas ao LES. O teste de associaçäo pelo x2 foi realizado com o objetivo de avaliar a associaçäo entre as variáveis independentes e o óbito. As curvas de sobrevida foram calculadas utilizando o método de Kaplan-Meier e os fatores de risco foram estimados pelo modelo de riscos proporcionais de Cox. Os fatores prognósticos para o óbito dos pacientes com LES foram a presença de insuficiência renal terminal (razäo de risco-HR=2,73), de envolvimento pulmonar isolado (HR=2,94) ou associado com envolvimento cardíaco (HR=3,77) e a utilizaçäo de imunossupressor (HR=0,45). Os fatores prognósticos para o óbito dos pacientes com nefrite lúpica foram a presença de insuficiência renal terminal (HR=2,75) e a utilizaçäo de imunossupressor (HR=0,24). Os fatores de risco para o desenvolvimento de insuficiência renal terminal dos pacientes com LES foram a idade no início da doença entre 7 e 15 anos (HR=3,61), a presença de hipertensäo arterial sistêmica (HR=5,21) e a presença de anemia hemolítica (HR=9,35). O fator de risco para a perda da funçäo renal dos pacientes com nefrite lúpica foi a presença de alteraçäo hematológica do tipo anemia hemolítica (HR=3,64) ou plaquetopenia (HR=6,69).

Systemic lupus erythematosus in males.

Systemic Lupus Erythematosus is a disease commonly seen in women. A few male kindreds have however been described. In this study, twelve male patients of a series of 175 patients with SLE have been analysed. Arthritis was the most frequent manifestation observed. Renal involvement was seen in as many as 41.65% of patients.

Glomerulonephritis in Kelantan, Malaysia: a review of the histological pattern.

Renal biopsy is essential in the management of renal parenchymal diseases. Thus far there is no publish report on the pattern of glomerulonephritis in Kelantan. We decided to establish the pattern of glomerulonephritis in Kelantan and use this information as our reference in future studies. Records of patients who had proven glomerulonephritis histologically were analysed. Their biological data, clinical presentation, etiology and clinicopathological pattern were studied. Where appropriate mean and standard deviation were calculated. A total of 74 biopsies were performed during the study period (between January 1991 and December 1993), out of which 72 biopsies (97.3%) were considered suitable for analysis. The male to female ratio was 1:1.1. Mean age at presentation was 27.6 +/- 12.2 years. Nephrotic syndrome was the commonest clinical presentation (65.3%). The main underlying cause was systemic lupus erythematosus (50%) followed by primary glomerulonephritis. Histologically, IgA nephropathy and minimal change disease were the main patterns among patients with primary glomerulonephritis while diffuse proliferative glomerulonephritis was the commonest pattern among patients with lupus nephritis. Hence the pattern of glomerulonephritis is similar to other reported series. The procedure is considered safe and has a high success rate.

Lupus nephritis in males: 8-year experience at Siriraj Hospital.

During 1984 to 1991, 54 out of 569 lupus nephritis patients at Siriraj Hospital were male (F:M sex ratio = 10:1). Mean age of the males was 29.8 +/- 14.6 years, range 12 to 69. The three most common extrarenal manifestations were anemia, cutaneous, and musculoskeletal involvement (74.5, 51.1, and 43.9%, respectively). The major renal manifestations were edema (75.9%) with heavy proteinuria over 3.5 g/day in 62.2% and nephrotic/nephritic findings in 51.9% of cases. Hypertension was found in 35.2%. Mean serum creatinine was 2.0 +/- 1.4 mg/dl while 60.5% of cases had creatinine clearance below 50 ml/minute. Mean serum albumin was 2.6 +/- 0.8 g/dl, cholesterol 262.8 +/- 129.5 and triglycerides 343.2 +/- 244.6 mg/dl. Interestingly, hypercholesterolemia (> 250 mg/dl) was found only in 44.8% of cases with nephrotic syndrome. Antinuclear antibody was demonstrated in 91.5%, anti-dDNA antibody in 64.4% and LE cells in 40.4% of cases. Renal biopsy was done in 45 patients and 30 cases (66.7%) were classified as diffuse proliferative nephritis (WHO type IV), 15.6% of type II, 6.7% each of type III and V, with the rest of type V plus IV (4.4%). Tubulointerstitial inflammation was found in 77.3% of cases. During the follow-up period (42 +/- 35.8 months), 6 patients died. The cause of death were uremia in 3, infection in 2, and cardiac failure in 1. By life-table analysis, the probabilities of survival for 1 and 5 years were 89.5 and 80.6%, respectively. In comparison between sexes, except for a higher amount of urinary protein excretion (4.5 +/- 3.1 vs 3.5 +/- 3.0 g/day, p < 0.05), there were no statistically significant differences in clinical and pathological parameters, and probability of survival.