Biji Anilkumar, Saji Francis

BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple organ systems either simultaneously or sequentially with relapsing and remitting course.1 Renal disease affects 38% of patients with SLE, with a range of 12–69% and it adds significantly to the morbidity and mortality of SLE patients.2 Although the availability of dialysis, transplantation and immunosuppressive therapy have improved patient survival, approximately 20% of SLE patients still die from disease or associated complications.3 In this study, we evaluated the clinical and pathological changes in lupus nephritis and tried to evolve simple criteria to predict cases that have poor outcome. The objectives of the study were - 1. To evaluate and compare the clinical outcome of lupus nephritis patients having different clinical and histological parameters. 2. To construct a scoring system for predicting cases with bad outcome. MATERIALS AND METHODS Lupus nephritis patients diagnosed by renal biopsy in a 4½ year period were reassessed. They were grouped into Poor outcome group (Death due to disease or serum creatinine of ≥2 mg/dl) and Good outcome group (all others). Activity and chronicity indices and other glomerular, tubular and vascular variables in the renal biopsy were semi quantitatively graded. These variables and the initial clinical parameters were compared in the two groups. A predictive scoring system was constructed with the significantly different parameters. The data was analysed with the help of computer software SPSS. RESULTS 40 cases with adequate follow up were available with minimum 2 years and maximum 12 years follow up. 12 cases belonged to the poor outcome and 28 cases to the good outcome groups. The variables that significantly differed in the two outcome groups were added up for a predictive score namely serum creatinine, tubular atrophy, tubular dilatation, interstitial fibrosis and histological class IV. Predictive scores ≥5 had sensitivity and specificity of 0.75 for predicting cases with adverse outcome. CONCLUSION Initial serum creatinine and selected graded parameters on renal biopsy can predict eventual outcome of Lupus nephritis with fairly high sensitivity and specificity.