Raouf Rahim MERZA, Ayar Omer ALİ, Hawar Ali Ehsan Kaka KHAN

Lupus Nefritinin Klinikopatolojik Çalışması

Amaç:Lupus nefriti sistemik lupuseritematozusun en ciddi belirtilerinden biridir ve morbidite ve mortalitenin esas sebebidir. Bu çalışmanın amacı lupus nefriti olgularında erkek ve kadınlar arasında karşılaştırma yapmaktır. Materyal ve Metod:Biyopsi ile Lupus nefriti olduğu kanıtlanmış 45 hasta (32 kadın, 13 erkek) üzerinde kesitsel çalışma uygulandı. Tüm hastalara anket yapıldı. Hastalara biyokimyasal, immünolojik, serolojik, hematolojik tetkikler ve idrar tahlili yapıldı. 24 saatlik idrarda protein atılımına bakıldı. Bulgular:Yapılan çalışmaya göre kadınların (32, %71.1) erkeklere (13, %28.9) nazaran daha baskın olduğu görülmüştür. En yaygın tip olarak 4. sınıf nefriti (15, %33.3) sonrasında ise 3. sınıf nefriti (9, %20.9) görülmüştür.Sistemik lupuseritematozuslu erkek hastalar, kadınlardan daha erken bir dönemde nefriti geliştirmişlerdir.Erkeklerde daha yaygın hipertansiyon ve ödem vardı.Kadınlarda böbrek dışında en yaygın belirti mukokutanöziken erkeklerdehematolojik, kardiyovasküler, solunum ve merkezi sinir sistemi manifestasyonu görülür.Kadınlara nazaran erkeklerde daha fazla proliferatif tipte lupus nefriti gözlenmiştir. Sonuç:Erkeklerde kadınlara nazaran daha ciddi tipte lupus nefriti görülmüştür.

Anahtar Kelimeler:

Sistemik lupuseritematozus, Lupus nefriti, cinsiyet

The Clinicopathological Study of Lupus Nephritis

Purpose: Lupus nephritis is one of the most serious manifestations of Systemic lupus erythematosis and it is a major cause of morbidity and mortality. The aim of this study is to compare males and females in lupus nephritis presentations. Material and Methods: A cross-sectional study performed on forty five patients with biopsy proven Lupus Nephritis including 32 females and 13 males. All patients assessed by questionnaire form and investigated for hematological, biochemical, immunological, serological, urinalysis, and 24hrs urinary protein excretion. Results: The current study shows female predominance 32(71.1%) compared with 13(28.9%) male. Class IV 15(33.3%) nephritis was the most common type followed by class III 9(20.9%).The male patients develop nephritis early in the course of Systemic lupus erythematosis than females, and they were more commonly had hypertension and edema, and the hematological, cardiovascular, pulmonary, and central nervous system were the most common extra renal manifestation in males while mucocutaneous manifestations were the commonest in females, and further more males had more proliferative type of Lupus nephritis than females. Conclusion: Males had more severe type of lupus nephritis than females.

Keywords:

Systemic lupus erythematosis, Lupus nephritis, sex,

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Alba P, Bento L, Cuadrado MJ, et al. Anti-ds DNA, anti-Sm antibodies, and the lupus anticoagulant; significant factors associated with lupus nephritis. Ann Rheum Dis. 2003;62:556-60.
Popescu E, Ionescu R. Systemic lupus erythematosus, In: Compendium of rheumatolgy, Bucharest. 2000;117-33.
Christian Cl, Elkon Kb: Autoantibodies to intracellular proteins. Clinical and biological implications. Am J Med. 1986;80:53-61.
Cochrane Cg, Koffler D: Immune complex disease in experimental animals and man. AdvImmunol 1973;16:186-264.
Lu LJ, Wallace DJ, Ishimori ML, Scofield RH, Weisman MH. Review: male systemic lupus erythematosus: a review of sex disparities in this disease. Lupus. 2010;19:119–29.
Garcia MA, Marcos JC, Marcos AI et al. Male systemic lupus erythematosus in a Latin-American incepcion cohort of 1214 patients. Lupus. 2005;14,938-46.
Soto ME, Vallejo M, Guillén F, Simón JA, Arena E, Reyes PA. Gender impact in systemic lupus erythematosus. ClinExpRheumatol. 2004;22:713-21.
Hochberg MC, Boyd RE, Ahearn JM et al. Systemic lupus erythematosus: a review of clinico-laboratory features and inmunogenetic markers in 150 patients with emphasis on demographic subsets. Medicine (Baltimore). 1985;64:285-95.
Medina G, Vera-Lastra, Barile L, Salas M, Jara LJ. Clinical spectrum of males with primary antiphospholipid syndrome and systemic lupus erythematosus: a comparative study of 73 patients. Lupus. 2004;13:11-6.
Mak A, Mok CC, Chu WP, To CH, Wong SN, Au TC: Renal damage in systemiclupus erythematosus: a comparative analysis of different age groups. Lupus. 2007;16:28-34.
Seligman VA, Lum RF, Olson JL, Li H, Criswell LA: Demographic differences in the outcome ofSLE nephritis: a retrospective analysis. Am J Med. 2002;112:726-9.
Voulgari PV, Katsimbri P, Alamanos Y, Drosos AA. Gender and age differences in systemic lupus erythematosus. A study of 489 Greek patients with a review of the literature. Lupus. 2002;11:722–9.
Sthoeger ZM, Geltner D, Rider A, Bentwich Z. Systemic lupus erythematosis 49 Israeli males: a retrospective study. ClinExpRheumatol. 1987;5:233–
Kaufman LD, Gomez-Reino JJ, Heinicke MH, Gorevic PD. Male lupus: retrospective analysis of the clinical and laboratory features of 52 patients, with a review of the literature. Semin Arthritis Rheum. 1989;18:189–97.
Molina JF, Drenkard C, Molina J, et al. Systemic lupus erythematosis in males. A study of 107 Latin American patients. Medicine (Baltimore). 1996;75:124–30.
Garcia MA, Marcos JC, Marcos AI, et al. Male systemic lupus erythematosus in a Latin-American inception cohort of 1214 patients. Lupus. 2005;14:938–46.
Andrade RM, Alarco n GS, Fernandez M, Apte M, Vila LM, Reveille JD. Accelerated damage accrual among men with systemic lupus erythematosus: XLIV. Results from a multiethnic US cohort. Arthritis Rheum. 2007;56:622–30.
Mok CC, Lau CS, Chan TM, Wong RW. Clinical characteristics and outcome of southern Chinese males with systemic lupus erythematosus. Lupus. 1999;8:188–96.
Chang DM, Chang CC, Kuo SY, Chu SJ, Chang ML. The clinical features and prognosis of male lupus in Taiwan. Lupus. 1998;7: 462–8.
Specker C, Becker A, Lakomek HJ, Bach D, Grabensee B. Systemic lupus erythematosus in men—a different prognosis? Z Rheumatol. 1994;53:339–45.
Mok CC, Ying KY, Ng WL, et al. Long-term outcome of diffuse proliferative lupus glomerulonephritis treated with cyclophosphamide. Am J Med. 2006;119:355. e25–e33.
LaenaOngaJyooth, ChairatShayakul, PalsalParlchatikanond et al , Lupus Nephritis in Males: 8-Year Experience at Siriraj Hospital; Asian Pacific Journal of Allergy and Immunology. 1994;12:87-93
Boumpas DT, Austin HA, Fessler BJ, et al. Systemic lupus erythematousus, emerging concepts. Renal, neurospychatric, cardiovascular, pulmonary, and hematologic disease. Ann Intern Med. 1995;122:940
Andrew S. Bomback and Gerald B. Appel, Updates on the Treatment of Lupus Nephritis; J Am SocNephrol 21: 2028–2035, 2010. doi: 1681/ASN.2010050472
AppelGB,RadhakrishnanJ,D’AgatiV:Secondary glomerular diseases.BrennerB,ed.The Kidney, Philadelphia:Saunders Elsevier;2008:1067-1147.
Jacobsen S, Petersen J, Ullman S, et al. A multicenter study of systemic lupus erythematousus in 513 Danish patients. II Mortality and factors of prognostic value Clin Rheumatol.1998;17:478-84.
Zahra Mirfeizi, Mahmoud Mahmoudi , MasihNaghibi et al. Urine Monocyte Chemoattractant Protein1(UMCP-1) as a Biomarker of Renal Involvement in Systemic Lupus Erythematosus, Iranian Journal of Basic Medical Sciences 2012;15:1191-5.
Khader N. Mustafa ,Tariq N. Aladily,Maha S. Shomaf et al ;Renal Biopsy Findings in Lupus Nephritis ,Saudi J Kidney Dis Transpl. 2011;22:815-7.
Luo Ping Lu Shan Lu, XuehongLuoman Yu. 60 cases of lupus nephritis clinical and pathological analysis, CLC 2008: R593.242.
Mumtaz Patel, Alexandra M. Clarke, Ian N. Bruce et al, The Prevalence And Incidence Of Biopsy-Proven Lupus Nephritis In The Uk Arthritis & Rheumatism. 2006;54:2963–9.
Huong DLT, Papo T, Beaufil H, et al. Renal involvement in systematic lupus erythematosus. A study of 180 patients from a single center. Medicine (Baltimore). 1999;78:148-66.
Derksen RH, Hene RJ, Kater L. The long-term clinical outcome of 56 patients with biopsy-proven lupus nephritis followed at a single center. Lupus. 1992;1:97-103.
Seedat YK, Parag KG, Ramsaroop R. Systematic lupus Erythematosus and renal involvement. A South Africa experience. Nephron. 1994;66:426-30.
Shayakul C, Parichatikanond P, Ongayooth L, et al. Lupus nephritis in Thailand: clinicopathologic findings and outcome in 569 patients. Am J Kidney Dis. 1995;26:300-07.
Chu SJ, Chang DM, Kuo SY, et al. Lupus nephritis:an analysis of 70 cases. Zhonghua Yi XueZaZhi (Taipepi). 1994;53:27-36.
Wang Caili, Liu Yuchun, Wang Hai, et al. Lupus Nephritis In Male Adults, An Analysis Of The Clinical And Pathological Features, The Institute Of Nephrology, Beijing Medicaluniversity.1995;12:100
LaenaOngaJyooth, ChairatShayakul, PalsalParlchatikanond et al. Lupus Nephritis in Males: 8-Year Experience at Siriraj Hospital, Asian Pacific Journal of Allergy and Immunology. 1994;12:87-93.
Y-F Wang, Y-X Xu, Y Tan, et al, Clinicopathological characteristics and outcomes of male lupus nephritis in China, Lupus. 2012;21:1472.
Niang A, Ka EF, Dia D , et al. lupus nephritis in Senegal; a study of 42 cases, Saudi J Kidney Dis Transpl 2008;19:470-74.
VarunDhir, Amita Aggarwal, Able Lawrence et al, Long-Term Outcome of Lupus Nephritis in Asian Indians, Arthritis Care & Research. 2012;64:713–20.
Preetha A, S.D. Tarey, Girija Singh. Renal Manifestations In Patients With Systemic Lupus Erythematosus, St. John’s Medical College & Hospital, Bangalore. 2006;560 034.
Carlos Franco, WonsukYoo, Domingo Franco, Predictors of End Stage Renal Disease in African Americans with Lupus Nephritis, Bulletin of the NYU Hospital for Joint Diseases. 2010;68:251-6.
Soni S. S,S.Gowrishankar,G.K.Adikey et al; sexbased differences in lupus nephritis: a study of 235 Indian patients J Nephrol. 2008;21:570–5.
Ana Karla Guedes de Melo, Alessandra Barbosa Avelar ,FláviaKamyMarcielMaegawa et al; Analysis of 100 patients with lupus nephritis followed up for 2 years, Rev Bras Reumatol. 2009;49:8-19.
Garcia MA, Marcos JC, Marcos AI et al. Male systemic lupus erythematosus in a Latin- American incepcion cohort of 1214 patients. Lupus. 2005;14:938-46.
M.E. Soto, M. Vallejo, F. Guillén , Gender Impact In Systemic Lupus Erythematosis , Clinical And Experimental Rheumatology. 2004;22:713-21.
Rabbani MA, Ahmad B, Shah SM, et al. Clinicolaboratory findings in male lupus patients from a tertiary care hospital, Pakistan. J Pak Med Assoc. 2005;55:165-6 .
Sthoeger ZM, Geltner D, Rider A et al.Systemic lupus erythematosus in 49 Israeli males: a retrospective study. ClinExpRheumatol. 1987;5:233
Kaufman LD, Gomez-Reino JJ, Heinicke MH et al. Male lupus: retrospective analysis of the clinical and laboratory features of 52 patients, with a review of the literature. Semin Arthritis Rheum. 1989;18:189-197.
Hitoshi Yokoyama, Takashiwada, Akinori Hara et al, The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese, Kidney International. 2004;66:2382–8.
Jim LC Yong, Murray C Killing, Ken Lai. Renal biopsy pathology in a cohort of patients from southwest Sydney with clinically diagnosed systemic lupus erythematosis, International Journal of Nephrology and Renovascular Disease. 2013;6:15
SiminTorabiNezhad, RoushakSepaskhah. Correlation of clinical and pathological finding in patients with lupus nephritis, Saudi J Kidney Dis Transpl. 2008;19:32-40.
WANG Guo-bao, XU Zheng-jin, LIU Hong-fa et al, Changes in pathological pattern and treatment regimens based on repeat renal biopsy in lupus nephritis, Chin Med J. 2012;125:2890-4.
De Carvalho JF, do Nascimento AP, Testagrossa LA et al, Male gender results in more severe lupus nephritis, Rheumatol Int. 2010;30:1311-5.
Habib Emre, YaseminUsulSoyoral, HüseyinBeğenik et al, Analysis of Patients With Lupus Nephritis: A Single Center’s Experience Van Tıp Dergisi. 2011;18:101-5.
McHardy KC, Horne C, Rennie J. Antinuclear antibody-negative SLE: how common? J ClinPathol. 1982;35:1118–21.
Reichlin M. ANA negative systemic erythematosus sera revisited serologically. Lupus. 2000;9:116–19.
Kavanaugh A, Tomar R, Reveille J et al. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. Arch Pathol Lab Med. 2000;124:71–81.
Uthman IW, Muffarij AA, Mudawar WA et al. Lupus nephritis in Lebanon, Lupus. 2001;10:378-81.
G Moroni, A Radice, G Giammarresi et al; Are laboratory tests useful for monitoring the activity of lupus nephritis? A 6-year prospective study in a cohort of 228 patients with lupus nephritis, Ann Rheum Dis. 2009;68:234–7.
Al-Attia HM, Al Ahmed YH, Chandani AU. Serological markers in Arabs with lupus nephritis. Lupus Nephritis. Lupus. 1998;7:198-201.
Rahman A, Isenberg DA: Mechanisms of disease. Systemic Lupus Erythematosus. The N England J of Medicine. 2008,358:929-39.
Fries JF, Holman HR. Systemic lupus erythematosus: clinical analysis.MajorProbl Inter Med. 1975;6:199.
Molina JF, Drenkard C, Molina J et al. Systemic lupus erythematosus in males. A study of 197 Latin American patients. Medicine (Baltimore). 1996;75:124-30.
DrakoulogkonaOurania, RîcăIoana, BărbulescuAndreea. Immunological Profile in Patients with Lupus Nephritis and Correlations with the Histological Pattern, Current Health Sciences Journal. 2011;37:161-4.
P Alba, L Bento, M J Cuadrado et al, Anti-dsDNA, anti-Sm antibodies, and the lupus anticoagulant: significant factors associated with lupus nephritis, Ann Rheum Dis. 2003;62:556–60.
ParvizKhajehdehi,GhanbaraliRais-Jalali. Comparison Between Males And Females With Lupus Nephritis. Nephrology. 1997;3:353–6.
YazışmaAdresi / Address for Correspondence: Dr.Hawar Ali Ehsan Kaka Khan Sulaimaniya General Hospital IRAQ E-mail: haekkam@gmail.com G eliştarihi/Received on : 02.04.2014
Kabul tarihi/Accepted on:30.04.2014