الفهرس 
Lupus nephritisOnly 14 pages are availabe for public view
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Abstract
LN is a serious and common manifestation of systemic lupus erythematosus (SLE) and a major risk factor for morbidity and mortality. Usually, 10%–20% of patients end up in end stage kidney disease (ESKD). Active nephritis and chronic kidney damage share common presentation of proteinuria and impaired kidney function. Differentiation between active nephritis and damage is essential for determination of the proper management plan without delays in activity and without unnecessary immunosuppression in the context of damage. Currently used biomarkers lack sufficient sensitivity and/or specificity to detect active renal inflammation.
The aim of the study was to evaluate the diagnostic value of urinary sCD163 in children with active lupus nephritis and its relation to serum and urinary parameters of lupus activity.
This was a comparative controlled cross-sectional study that was conducted at Pediatric Allergy, Immunology and Rheumatology and Pediatric Dialysis and Nephrology Units, Children’s hospital, Ain Shams University, Cairo, Egypt, on 60 subjects, who were divided into 4 groups (15 per group), group 1 was SLE patients with active LN, group 2 was lupus patients with activity other than renal activity, group 3 was patients with non-lupus renal disease, not on hemodialysis, while group 4 was healthy age matched control. The study was conducted over a period of 6 months.
The most frequent histological class found in renal biopsies among 15 LN patients was class V (7/15, 46.6%), followed by class III (4/15, 26.6%), class IV (2/15, 13.3%), and class II (2/15, 13.3%). It was observed that, the only male patient with LN had class IV.
It was found that patients with active LN had a significant higher urinary sCD163 level than the other studied groups (p= 0.008), thus urinary sCD163 may act as a good marker for predicting renal activity in lupus patients and discriminate between lupus and non-lupus renal as urinary sCD163 had perfect discriminative value with an area under the ROC curve (AUC) of 1.0 (p <0.001). Furthermore, urinary sCD163 had perfect discriminative value with an area under the ROC curve (AUC) of 1.0 (p <0.001). A cutoff criterion >110 ng/ml could differentiate between inflammatory and non-inflammatory nephropathy with sensitivity of 100% and specificity of 100%.
There was a significant positive correlation between urinary sCD163 and the renal biopsy activity index in LN patients, but no correlation with the chronicity index was found.
Urinary sCD163 was significantly higher in Lupus patients with renal BILAG A and BILAG B compared to BILAG E
There was no correlation between urinary sCD163 and anti-dsDNA or serum C3.
Moreover, there was no significant difference between levels of urinary sCD163 in different histopathological classes of LN, however, a higher median serum sCD163 levels were observed in proliferative type LN; classes III and IV.
In lupus patients (group 1 & 2), there was a positive correlation between urinary sCD136 and 24 h urinary protein excretion and Prednisolone dose.
Also, there was a weak negative correlation between urinary sCD136 and GFR and SLEDAI score, while there was no correlation between urinary sCD136 and the other studied variables.
Limitations of the study
The present study has several points of limitation including the cross-sectional nature of the study and the small sample size, lack of histopathological findings among non-renal lupus patients, lack of inactive LN group and lack of gender matching among the 4 groups were also considered a limiting point. The renal biopsies were not necessarily taken at time of enrolment. The correlation to serum sCD163 would have provided more informative data.
Conclusion
In conclusion, the significantly elevated urine sCD163 in pediatric patients with active LN can be used as a potential noninvasive biomarker for LN activity. Its level is associated with clinical features, laboratory, and pathological indices of lupus nephritis activity. Further studies are needed to evaluate the predictive value of sCD163 in lupus patients to predict LN and to evaluate its activity over the disease course.
Recommendations:
Wider scale longitudinal studies are needed with recruitment of larger number of lupus cases with inclusion of adequate number of all histopathological classes of LN. Investigation of the predictive value of sCD163 in urine to predict the renal flare in lupus patients. Investigate serum sCD163 in relation to urine level and comparing their values to other potential LN biomarkers.