Native Renal Biopsy: An Essential Diagnostic Tool in Systemic Lupus Erythematosus
Keywords:
Systemic lupus erythematosus, native renal biopsy, light microscopy, immunofluorescence.
Abstract
Background – Systemic lupus erythematosus (SLE) is a connective-tissue disorder of autoimmune aetiology and presented with broad range clinical manifestation due to multisystem involvement. In spite of overall reduction in morbidity due to recent therapy, renal involvement is the leading cause of disease related mortality. Materials and Method We conducted a cross-sectional observational study to assess clinicopathological findings and to identify the prognostic association of histopathological parameters with advanced clinical stage. We included 31 patients met the diagnostic criteria of SLE according to revised criteria of the American College of Rheumatology (ACR) for SLE in 1997. Each native renal biopsy was examined by two trained pathologists by light microscopy and was classified using ISN/RPS 2003 lupus nephritis classification system. The Kruskal–Wallis test was performed for comparisons between multiple groups. Result Pedal edema were found to be the most common clinical presentations. . Female preponderance is noted in present study with male: female ratio 1:9.3. We found diffuse proliferative glomerulonephritis (class IV) as most frequent class with incidence rate of 54.8%. After combination of the variables along with different classes of lupus nephritis, significant statistical association was observed in endocapillary proliferation and neutrophillic in filtration as activity predicting factors. Silent LN has been observed in class II as well as in class IV disease also The most common deposited immunoglobulin was IgG. Conclusion Renal biopsy remains the main diagnostic tool in identification of exact stage of involvement because clinical staging may not accurately corroborate with histopathological staging.References
Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 2003; 8 2: 299–308.
2. Font J, Cervera R, Ramos-Casals M, Garcia-Carrasco M, Sents J, Herrero C et al: Clusters of clinical and immunologic features in systemic lupus erythematosus: analysis of 600 patients from a single center. Semin Arthritis Rheum 2004; 3 3: 217–230.
3. Seligman VA, Lum RF, Olson JL, Li H, Criswell LA. Demographic differences in the development of lupus nephritis: A retrospective analysis. Am J Med. 2002;112(9):726-729.
4. Bastian HM, Roseman JM, McGwin G Jr, Alarcon GS, Friedman AW, Fessler BJ, et al. Systemic Lupus erythematosis in three ethnic groups. XII. Risk factors for lupus nephritis after diagnosis. Lupus. 2002;11(3):152-160.
5. Clinical features of SLE. In: Textbook of Rheumatology, Kelley WN, Firestein GS, Budd RC, Gabriel SE, McInns IB, O’Dell JR `(Eds), WB Saunders, Philadelphia 2000.
6. Christopher-Stine L, Siedner M, Lin J, Haas M, Parekh H, Petri M, Fine DM: Renal biopsy in lupus patients with low levels of proteinuria. J Rheumatol 34: 332–335, 2007.
7. Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB et al. International Society of Nephrology Working Group on the Classification of Lupus Nephritis; Renal Pathology Society Working Group on the Classification of Lupus Nephritis: The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 2004; 6 5: 521–530.
8. Mok CC, Mak A, Chu WP, To CH, Wong SN: Long-term survival of southern Chinese patients with systemic lupus erythematosus: a prospective study of all age-groups. Medicine (Baltimore) 2005; 8 4: 218–224.
9. Lalani S, Pope J, de Leon F, Peschken C; Members of CaNIOS/1,000 Faces of Lupus: Clinical features and prognosis of late-onset systemic lupus erythematosus: results from the 1,000 faces of lupus study. J Rheumatol 2010; 3 7: 3 8–44.
10. Carreno L, Lopez-Longo FJ, Monteagudo I, Rodriguez-Mahou M, Bascones M, Gonzalez CM et al. Immunological and clinical differences between juvenile and adult onset of systemic lupus erythematosus. Lupus 1999; 8 : 2 87–292.
11. Font J, Cervera R, Espinosa G, Pallares L, Ramos-Casals M, Jimenez S et al. Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparison with SLE characteristics in adults. Ann Rheum Dis 1998; 5 7: 4 56–459.
12. Tarakemeh T. Use of renal biopsy in predicting outcome in lupus nephritis. Shiraz E-Medical Journal. 2002;3:28-31.
13. Gun HC, Yoon KH, Fong KY. Clinical outcomes of patients with biopsy-proven lupus nephritis in NUH. Singapore Med J. 2002;43:614-6.
14. Kosaraju K, Shenoy S, Suchithra U. A cross- sectional hospital bases study of autoantibody profile and clinical manifestation of systemic lupus erythematosus in south indian patients. Indian J Med Microbiol. 2010;28:245-7.
15. Nezhad ST, Sepaskhah R. Correlation of clinical and pathological findings in patients with lupus nephritis: a five year experience in Iran. Saudi Journal of kidney disease and transplantation. 2008;19: 32-40.
16. Liu ZH, Cheng ZH, Gong RJ, Liu H, Liu D, Li LS: Sex differences in estrogen receptor gene polymorphism and its association with lupus nephritis in Chinese. Nephron 2002; 9 0: 1 74–180.
17. Kafle MP, Shah SD, Shrestha S, Sigdel MR, Raut KB. Prevalence of specific types of kidney disease in patients undergoing kidney bIopsy: a single centre experience. Journal of Advances in Internal Medicine 2014;03(01):5-10..
18. Shobha V, Prakash R, Arvind P, Tarey SD. Histopathology of lupus nephritis: A single-center, cross-sectional study from Karnataka, India. IJRCI. 2014;2(1):OA3
19. Schur PH, Berliner N. Hematologic manifestations of systemic lupus erythematosus in adults. In: UpToDate, Pisetsky DS, editor. Waltham, MA: UpToDate; 2017. https://www.uptodate.com/contents/ hematologic-manifestations-ofsystemic-lupus-erythematosus-in.
20. Dhakal SS, Sharma SK, Bhatta N, Bhattarai S, Karki S, Shrestha S, et al. Clinical features and histological patterns of lupus nephritis in Eastern Nepal. Saudi J Kidney Dis Transpl. 2011;22(2):377-80.
21. Vozmediano C, Rivera F, López-Gómez J, Hernández D. Risk Factors for Renal Failure in Patients with Lupus Nephritis: Data from the Spanish Registry of Glomerulonephritis . Nephron Extra 2012;2:269–277.
22. Rush P, Baumal R, Shore A, Balfe J, Schreiber M. Correlation of renal histology with outcome in children with lupus nephritis. Kidney International, Vol. 29 (1986), pp. 1066—1071.
23. Nossent H, Berden J, Swaak T. Renal immunofluorescence and the prediction of renal outcome in patients with proliferative lupus nephritis. Lupus. 2000;9:504-10.
24. Das R, Saleh A, Kabir A, Talukder SI, Kamal M. Immunofluorescence Studies of Renal Biopsies. Dinajpur Med Col J. 2008;1:8-13.
2. Font J, Cervera R, Ramos-Casals M, Garcia-Carrasco M, Sents J, Herrero C et al: Clusters of clinical and immunologic features in systemic lupus erythematosus: analysis of 600 patients from a single center. Semin Arthritis Rheum 2004; 3 3: 217–230.
3. Seligman VA, Lum RF, Olson JL, Li H, Criswell LA. Demographic differences in the development of lupus nephritis: A retrospective analysis. Am J Med. 2002;112(9):726-729.
4. Bastian HM, Roseman JM, McGwin G Jr, Alarcon GS, Friedman AW, Fessler BJ, et al. Systemic Lupus erythematosis in three ethnic groups. XII. Risk factors for lupus nephritis after diagnosis. Lupus. 2002;11(3):152-160.
5. Clinical features of SLE. In: Textbook of Rheumatology, Kelley WN, Firestein GS, Budd RC, Gabriel SE, McInns IB, O’Dell JR `(Eds), WB Saunders, Philadelphia 2000.
6. Christopher-Stine L, Siedner M, Lin J, Haas M, Parekh H, Petri M, Fine DM: Renal biopsy in lupus patients with low levels of proteinuria. J Rheumatol 34: 332–335, 2007.
7. Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB et al. International Society of Nephrology Working Group on the Classification of Lupus Nephritis; Renal Pathology Society Working Group on the Classification of Lupus Nephritis: The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 2004; 6 5: 521–530.
8. Mok CC, Mak A, Chu WP, To CH, Wong SN: Long-term survival of southern Chinese patients with systemic lupus erythematosus: a prospective study of all age-groups. Medicine (Baltimore) 2005; 8 4: 218–224.
9. Lalani S, Pope J, de Leon F, Peschken C; Members of CaNIOS/1,000 Faces of Lupus: Clinical features and prognosis of late-onset systemic lupus erythematosus: results from the 1,000 faces of lupus study. J Rheumatol 2010; 3 7: 3 8–44.
10. Carreno L, Lopez-Longo FJ, Monteagudo I, Rodriguez-Mahou M, Bascones M, Gonzalez CM et al. Immunological and clinical differences between juvenile and adult onset of systemic lupus erythematosus. Lupus 1999; 8 : 2 87–292.
11. Font J, Cervera R, Espinosa G, Pallares L, Ramos-Casals M, Jimenez S et al. Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparison with SLE characteristics in adults. Ann Rheum Dis 1998; 5 7: 4 56–459.
12. Tarakemeh T. Use of renal biopsy in predicting outcome in lupus nephritis. Shiraz E-Medical Journal. 2002;3:28-31.
13. Gun HC, Yoon KH, Fong KY. Clinical outcomes of patients with biopsy-proven lupus nephritis in NUH. Singapore Med J. 2002;43:614-6.
14. Kosaraju K, Shenoy S, Suchithra U. A cross- sectional hospital bases study of autoantibody profile and clinical manifestation of systemic lupus erythematosus in south indian patients. Indian J Med Microbiol. 2010;28:245-7.
15. Nezhad ST, Sepaskhah R. Correlation of clinical and pathological findings in patients with lupus nephritis: a five year experience in Iran. Saudi Journal of kidney disease and transplantation. 2008;19: 32-40.
16. Liu ZH, Cheng ZH, Gong RJ, Liu H, Liu D, Li LS: Sex differences in estrogen receptor gene polymorphism and its association with lupus nephritis in Chinese. Nephron 2002; 9 0: 1 74–180.
17. Kafle MP, Shah SD, Shrestha S, Sigdel MR, Raut KB. Prevalence of specific types of kidney disease in patients undergoing kidney bIopsy: a single centre experience. Journal of Advances in Internal Medicine 2014;03(01):5-10..
18. Shobha V, Prakash R, Arvind P, Tarey SD. Histopathology of lupus nephritis: A single-center, cross-sectional study from Karnataka, India. IJRCI. 2014;2(1):OA3
19. Schur PH, Berliner N. Hematologic manifestations of systemic lupus erythematosus in adults. In: UpToDate, Pisetsky DS, editor. Waltham, MA: UpToDate; 2017. https://www.uptodate.com/contents/ hematologic-manifestations-ofsystemic-lupus-erythematosus-in.
20. Dhakal SS, Sharma SK, Bhatta N, Bhattarai S, Karki S, Shrestha S, et al. Clinical features and histological patterns of lupus nephritis in Eastern Nepal. Saudi J Kidney Dis Transpl. 2011;22(2):377-80.
21. Vozmediano C, Rivera F, López-Gómez J, Hernández D. Risk Factors for Renal Failure in Patients with Lupus Nephritis: Data from the Spanish Registry of Glomerulonephritis . Nephron Extra 2012;2:269–277.
22. Rush P, Baumal R, Shore A, Balfe J, Schreiber M. Correlation of renal histology with outcome in children with lupus nephritis. Kidney International, Vol. 29 (1986), pp. 1066—1071.
23. Nossent H, Berden J, Swaak T. Renal immunofluorescence and the prediction of renal outcome in patients with proliferative lupus nephritis. Lupus. 2000;9:504-10.
24. Das R, Saleh A, Kabir A, Talukder SI, Kamal M. Immunofluorescence Studies of Renal Biopsies. Dinajpur Med Col J. 2008;1:8-13.
Published
2018-08-21
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