Clinical features and histological patterns of lupus nephritis in a single center of South India.

Renal involvement occurs in up to 60% of patients with systemic lupus erythematosus (SLE) and signifies a poor prognosis. The class of lupus nephritis (LN), determined on renal biopsy evaluation, guides the therapeutic management and has prognostic connotations. Our aim is to determine the clinicolaboratory features and histopathological patterns of LN at presentation in our local (South Indian) population. The study was conducted in a tertiary care hospital in South India between 2009 and 2014 on SLE patients with clinical evidence of LN. The renal biopsies were examined by light and immunofluorescence microscopy and were classified according to the International Society of Nephrology/Renal Pathology Society Classification of LN. A total of 46 patients were included, with age range of 12-60 years and a female to male ratio of 8.2:1. Arthritis, dermatological manifestations, and fever occurred, respectively, in 43.5%, 39.1%, and 30.4% of the cases. Class IV LN was present in 17 (37.1%), Class III LN in ten (21.7%), Class II LN in nine (19.5%), Class V LN in eight (17.4%), Class I LN in one (2.2%), and Class VI LN in one (2.2%) patients. Antinuclear antibody (ANA) and dsDNA positivity were present, respectively, in 82.6% and 65.2% of the patients. The most common pattern of LN was Class IV LN followed by Class III LN. Relatively higher proportions of ANA and anti-dsDNA positivity were present in proliferative LN, and there was a high frequency of arthritis at presentation in our LN patients.

Nondiabetic Renal Disease in type 2 Diabetes Mellitus Patients: A Clinicopathological Study.

BACKGROUND: The prevalence of nondiabetic renal disease (NDRD) among type 2 diabetics varies widely depending on the populations being studied and the selection criteria. Also, for patients found to have NDRD different predicting factors have been identified by different studies. OBJECTIVES: TO DETERMINE: (i) Frequency and spectrum of NDRD in type 2 diabetics with atypical clinical renal disease, in our set up and (ii) common clinical markers that are associated with NDRD in our local population. MATERIALS AND METHODS: Ninety-three type 2 diabetic patients with atypical clinical renal disease who had undergone renal biopsy to rule out NDRD were recruited. Patients were grouped into Group 1 with isolated NDRD, Group 2 with NDRD superimposed on diabetic nephropathy (DN), and Group 3 with isolated DN; and their clinical and biochemical parameters were statistically analyzed using analysis of variance, Kruskal-Wallis test, and Chi-square tests of statistical significance. RESULTS: 68.8% of the patients had NDRD with or without concurrent DN. Patients with isolated NDRD had shorter duration of diabetes compared to the other groups. Absence of retinopathy and presence of microscopic hematuria and active urinary sediment had positive predictive value of 79.24, 81, and 100%, respectively, for NDRD in type 2 diabetics. Chronic interstitial nephritis was the commonest NDRD and membranous glomerulonephritis was the commonest glomerular NDRD in our setup. INTERPRETATION AND CONCLUSIONS: The frequency of NDRD in type 2 diabetics with atypical clinical renal disease is high in our setup thereby making the renal biopsy procedure imperative to rule out the same. Shorter duration of diabetes, absence of retinopathy, presence of microscopic hematuria, and active urinary sediment are markers associated with NDRD in type 2 diabetes with clinical renal disease.