الفهرس 
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Abstract
Systemic Lupus Erythematosus is a chronic multifactorial systemic autoimmune disease affecting women more frequently than men and with a peak of incidence in childbearing age. Abnormal activation of the immune system, chronic inflammation, and tissue damage constitute the hallmark of the disease. SLE clinical manifestations are widely heterogeneous, ranging from mild symptoms of fatigue and oral ulcerations to life-threatening renal and neurologic disease complications. Typically, the disease fluctuates between clinical flares and quiescence; however, recurrent flares may lead to irreversible organ damage. The etiology of lupus has not been fully elucidated yet, but it has been associated with a variety of factors including genetic and epigenetic predisposition, female sex hormones, and environmental factors such as infections, Ultraviolet (UV) exposure and cigarette smoking. Vitamin D is a steroid hormone, primarily known for its role in the regulation of the calcium and phosphorus homeostasis and bone protection, a potential novel role for VD as a modulator of the immune system has been described too. Once activated, VD can exert its activity by binding VD Receptors (VDRs). In human, VDRs are widely expressed including numerous immune cells, suggesting that VD may play an essential function in controlling immune system responses. This finding has encouraged several studies aiming at elucidates the immunomodulatory properties of the vitamin D/VDR axis. Several reports confirmed a higher prevalence of VD deficiency amongst SLE patients compared to the general population, often also observing a correlation with the disease severity. Accordingly, many studies had been performed to identify potential link between low VD and lupus. Musculoskeletal pain, fatigue and depression are common in SLE, and low VD is implicated in these conditions. Disease activity in SLE was found to be inversely correlated with serum VD. Lupus Nephritis is one of the most serious consequences of SLE and is one of the major factors predicting poor outcome. Active LN can be the initial presentation in ” ” " ~ " ” ”30% of the patients with SLE and 10%-30% of SLE patients may develop ESRD 10 years after onset of LN. Renal involvement can interfere with with1α-hydroxylase enzyme that is essential to make active form of VD. This study aimed to assess the level of VD in the serum of patients with and without lupus nephritis and its association with disease activity, clinical and laboratory findings. This cross sectional study was conducted on 40 SLE patients diagnosed according to 2012 SLICC criteria or biopsy proven lupus nephritis with +ve ANA or anti-DNA. The participants were divided into 3 groups: • group I: 20 SLE patients with lupus nephritis. • group II: 20 SLE patients without lupus nephritis. • group III: 50 apparently healthy age and sex matched controls. All participants were subjected to complete history taking, complete clinical examination (the disease activity was assessed according to the SLEDAI) and laboratory investigation. Serum 25(OH) VD level by ELISA for patients and controls. Summary of our results: • Demographic data (age and gender) were insignificantly different among the three groups. While disease duration was significantly larger in SLE with nephritis than SLE without nephritis. • The clinical manifestations were insignificantly different between group I and II except vaculities and renal affection which were significantly higher in group I than group II. • CBC parameters were insignificantly different between group I and group II. • ESR, Creatinine, and P/C ratio were significantly higher in group I than group II, while CRP was insignificantly different between the two groups. • Anti-ds DNA positivity percent was significantly higher in group I than group II, while ANA, C3 and C4 were insignificantly different between the two groups. • RBCs in urine and positive urinary cast were significantly higher in group I than group II, Pus/HPF in urine was insignificantly different between the two groups. • SLEDAI and renal SLEDAI were significantly higher in SLE with nephritis. • 25(OH)D was significantly lower in SLE with nephritis than SLE without nephritis and control group, while it was insignificantly different between SLE without nephritis and control groups. • There was significant negative correlation between 25(OH)D and renal biopsy classes in group I. • There was significant positive correlation between 25(OH) D level and CBC parameters, while there was significant negative correlation with proteinuria, renal SLEDAI, SLEDAI and P/C ratio in group I. • Serum VD level was significantly reduced in patients with fatigue and musculoskeletal disorders, consumed C3, C4 and urinary cast in group I. • There was significant positive correlation between 25(OH) D and CBC parameters, while there was significant negative Correlation between 25(OH) D and SLEDAI. There was insignificant correlation between 25(OH) D level and age, duration, creatinine, proteinuria, pus in urine, RBCs in urine and CRP in group II. • Serum 25(OH) D level was significantly reduced in patients with fatigue, consumed C3&C4 and anti-ds DNA in group II.