Open Access Rheumatology: Research and Reviews (Sep 2022)
Silent Lupus Nephritis: Renal Histopathological Profile and Early Detection with Urinary Monocyte Chemotactic Protein 1
Abstract
Wesam Gouda,1 Aldosoky Abd elaziz Alsaid,2 Awad Saad Abbas,1 Tarek M Abdel-Aziz,1 Mohamed Z Shoaeir,1 Abd Allah S Abd Elazem,3 Mohammad Hamdy Sayed4 1Department of Rheumatology, Faculty of Medicine, Al Azhar University, Assiut, Egypt; 2Department of Internal Medicine, Faculty of Medicine, Al Azhar University, Assiut, Egypt; 3Department of Medical Biochemistry, Faculty of Medicine, Suez University, Suez, Egypt; 4Department of Pathology, Faculty of Medicine, Al Azhar University, Assiut, EgyptCorrespondence: Wesam Gouda, Rheumatology Department, Faculty of Medicine, Al Azhar University, Al Azhar University Square, Assiut, 71524, Egypt, Tel +201002753754, Email [email protected]: Lupus nephritis (LN) affects almost half of all individuals with systemic lupus erythematosus (SLE). Overt LN (OLN) symptoms might vary from asymptomatic microscopic hematuria to renal failure. However, when there are no clinical or laboratory indicators of renal involvement, some people with silent LN (SLN) may have pathological evidence of renal involvement identified by renal biopsy. Monocyte Chemotactic Protein 1 (MCP-1) is a chemotactic factor that promotes leukocyte migration to the kidney. MCP-1 urine levels (uMCP-1) have been demonstrated to be high in individuals with active LN. The purpose of this study was to discover the occurrence of SLN, as well as the possible variations between overt LN (OLN) and SLN across SLE patients based on the histopathological assessment, as well as the role of uMCP-1 in the early detection of SLN.Methods: An overall of 144 patients with SLE were included in the current research. Patients were subsequently divided into two groups: individuals who did not have clinical evidence of LN (84 patients) and those with OLN (60 patients). All the patients were subjected to the following investigations: uMCP-1, erythrocyte sedimentation rate (ESR), complement C3 (C3), complement C4 (C4), creatinine, albumin/creatinine ratio (uACR), creatinine clearance, quantitative assessment of proteinuria by 24-hour urine proteinuria (24hr UP) and percutaneous renal biopsy.Results: Sixty patients from group I (71.4%) showed glomerular lesions on renal biopsy (SLN), and class II was the predominant class. uMCP-1 had a sensitivity of 95.2% and a specificity of 98% in the detection of SLN, and uMCP-1 values were markedly higher in patients with OLN in comparison to SLN.Conclusion: The actual frequency of SLN may be higher than expected. High levels of uMCP-1 may have warranted the early activity of LN. uMCP-1 can be used as a non-invasive, useful tool for the prediction of LN.Keywords: systemic lupus erythematosus, silent lupus-nephritis, overt lupus nephritis, urinary chemotactic protein 1, renal biopsy
