A study to evaluate the correlation between serological profile and histopathology of lupus nephritis.

Vasudevan, C (2013) A study to evaluate the correlation between serological profile and histopathology of lupus nephritis. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION Systemic lupus erythematosus is an autoimmune disease of unknown etiology, characterized by the involvement of multiple organ systems . Organ damage is mediated by tissue binding autoantibodies and immune complexes. The hallmark of SLE is the presence of serum autoantibodies directed to nuclear constituents (i.e., antinuclear antibodies, ANA). In most of the patients, these autoantibodies are present for a few years before the first clinical symptoms appear. The clinical presentation and course of SLE are extremely variable. Some patients have spontaneous remissions; others may have mild musculoskeletal involvement which responds to therapy and a few die from progressive severe multisystem disease unresponsive to immunosuppressive therapy. Lupus nephritis is one of the common manifestations of SLE. Diagnosis of SLE is based on the 11 criteria defined by American Rheumatism Association (ARA). SLE patients develop wide range of autoantibodies. SLE commonly involves skin, joints, kidneys, serosal surfaces including pleura and pericardium, CNS and hematopoietic system. ANA is the most sensitive test for SLE and is present in more than 90% of patients but not specific for SLE. Anti dsDNA is a more specific but less sensitive marker of SLE. High titre of anti dsDNA correlates with disease activity and especially with lupus nephritis. Serum levels of complements C3 and C4 are usually decreased in active SLE and in active lupus nephritis. Most of the patients with active proliferative lupus nephritis have high titre of anti dsDNA and low C3 and C4 levels. Nowadays renal biopsy is recommended in almost all patients who have clinical or laboratory evidence of renal involvement to determine the histological class of lupus nephritis and thereby to plan therapy. But the requirement of renal biopsy has not been studied scientifically so far. So this study aimed to look at the need for renal biopsy in lupus nephritis scientifically. AIMS & OBJECTIVES : 1. To evaluate the correlation between serological profile and histopathology of lupus nephritis. 2. To find out the class of LN which has significant correlation with serological profile. 3. To define the positive predictive value of anti dsDNA and low complement levels with proliferative lupus nephritis. 4. To assess whether renal biopsy will alter the treatment plan in proliferative lupus nephritis. CONCLUSION : • In our study, serological profile of SLE had significant correlation with histopathology of lupus nephritis. • Anti dsDNA, low C3 and low C4 had significant independent correlation (p<0.05) with proliferative LN (class IV, IV&V). • Positive predictive value of all these three serological markers put together for proliferative LN was 97.4%. • None of the patients with class II or class V LN had the combination of anti dsDNA positivity, low C3 and low C4 levels. • So, we may suggest that serology alone is sufficient to predict the proliferative LN and there can be a case for starting immunosuppressive therapy without biopsy in a known SLE patient with evidence of LN and positive serology.

Item Type: Thesis (Masters)
Uncontrolled Keywords: lupus nephritis ; histopathology ; serological profile.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 06:44
Last Modified: 11 Jul 2017 06:44
URI: http://repository-tnmgrmu.ac.in/id/eprint/1390

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