الفهرس 
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Abstract
Systemic lupus erythematosus (SLE or lupus) is a systemic autoimmune disease characterized by generation of autoantibodies particularly against components in the cell nucleus (Rahman and Isenberg 2008).
SLE can affect any part of the body including the heart, joints, skin, lungs, blood vessels, liver, kidneys and nervous system. Lupus nephritis (LN) is one of the most serious complications of SLE and resembles an experimental immune complex–mediated glomerulonephritis (Koffler, Agnello et al. 1971).
Antinuclear antibody testing and anti-extractable nuclear antigen form the basis of serologic testing for SLE. However, ANA assay yields positive results in other disorders and autoimmune diseases, and may arise in normal individuals (Shabana, El-Ghawet et al. 2009)
Subtypes of antinuclear antibodies include anti-Smith, anti-double stranded DNA (dsDNA), anti-RNP (ribonuclear proteins) and anti-histone antibodies, etc. some of them were reported as highly specific for SLE and their levels in serum tended to reflect disease activities (Isenberg, Ravirajan et al. 1997; Sherer, Gorstein et al. 2004).
Up to date, however, it remains uncertain if the afore-mentioned autoantibodies may serve as a marker for disease activity of LN, as they are only present in serum of certain LN patients. Earlier reports showed that anti-dsDNA antibodies and other immunological parameters such as low complement hemolytic 50, C3 and C4 or the presence of anti-nucleosome antibodies showed moderate sensitivity and a moderate negative predictive value for LN (Cortes-Hernandez, Ordi-Ros et al. 2004; Linnik, Hu et al. 2005).
Our study group included seventy LN patients 91.4% females and 8.6% males, the mean age was 30 years, and it ranged from 17 to 66 years, the duration of the disease ranged from 5 to 156 months with a mean of 39 months.
In our study we evaluated the clinical relevance of triple positivity of the three antibodies (3-pos) as a marker for severe renal disease activities, the group of 3-pos (n = 16) and non 3-pos (n = 54) in the total of 70 LN patient group were compared with respect to related clinical and serological parameters.
Regarding correlation between the lupus nephritis class and 3 antibodies (anti-nuclsome , anti-ds DNA, anti histone ) we found a higher frequency of diffuse proliferative glomerulonephritis (class IV) in 3-pos patients than that in non 3-pos patients (38.5%vs. 9.2%), Furthermore, the prevalence of 3-pos antibodies ( nuclsome, DS-DNA, Histone) in patients with proliferative renal lesions (class III + IV) (was significantly higher than that in patients with non proliferative renal lesions (class I + II) and those with membranous lesions (class V) ,this was near to the results of (Mjelle, Rekvig et al. 2011) (Sui, Lin et al. 2013; Yang, Xu et al. 2015)( Ng, Manson et al. 2006).
IN our study we found that Anti-Ds DNA was the most frequent antibodies appeared in LN patients by percentage (62.9%) then followed by Anti-Nucleosome (44.2%) then Anti-Ro60KD , Anti-Ro52KD and Anti-Histones by percentage ( 34.3%, 31.4% and 30% respectively ), but the least frequent antibody was Anti-Mi-2 by percentage (0%) ,this was near to the results of (Ahmed, Shigidi et al. 2017) who found that ,The ANA profile showed a positive anti-dsDNA in 48.4% of patients, anti-RO 52 antibodies in 41.9% and anti-SSm in 32.3%. Anti Scl 70 antibodies were not detected in any of the study population.
Our study confirmed that, simultaneous reactivity with anti-dsDNA, -nucleosome and histone antibodies (3-pos) in patients with SLE were highly relevant to LN pathology. Three-pos LN patients showed significantly higher serum levels of these antibodies, suffered from more severe renal damage and needed more intensive treatments than non-3-pos LN patients, indicating 3-pos as an indicative biomarker for severe LN, These findings are in agreement with (Shabana, El-Ghawet et al. 2009; Sui, Lin et al. 2013; Yang, Xu et al. 2015).
Conclusion
Our study clarified the role of joint reactivity of anti-dsDNA, -nucleosome and -histone antibodies in the diagnosis of lupus nephritis. Furthermore, our data suggest that the ability of co-positive anti-dsDNA, -nucleosome and -histone antibodies to predict renal disease activity, may lead to major additional benefit in the follow-up of these patients.
simultaneous reactivity with anti-dsDNA, -nucleosome and histone antibodies (3-pos) in patients with SLE were highly relevant to LN pathology. Three-pos LN patients showed significantly higher serum levels of these antibodies, suffered from more severe renal damage and needed more intensive treatments than non-3-pos LN patients, indicating 3-pos as an indicative biomarker for severe LN.