الفهرس 
• IntroductionOnly 14 pages are availabe for public view
Abstract
Systemic lupus erythematosus is the most serologically
and clinically diverse multisystem autoimmune disease
characterized by autoantibody production, immune complex
formation and immunologically mediated tissue injury.
Lupus nephritis is a prominent feature in SLE present in
15-30% of patients with lupus at the time of the initial diagnosis
and 30-50% during the disease progression.
Now, evidence that TWEAK contributes to the
pathogenesis of LN is accumulating due its role in promoting an
inflammatory response, renal cell proliferation, apoptosis,
vascular changes and fibrosis.
This study represents one of the studies that aimed to assess
the role of TWEAK in detecting the renal disease activity in patients
with SLE and to study the relation between TWEAK levels as
well as Fn14 with disease activity and pathological LN
classification.
The present study included thirty SLE patients who were
selected from outpatient clinic of Physical Medicine, Rheumatology
and Rehabilitation as well as Nephrology department of Ain Shams
University Hospitals, diagnosed according to SLICC criteria 2012
for SLE.
Summary and conclusion
(157)
They were divided into two groups, 15 newly diagnosed
LN patients, 11 females and 4 males, their ages ranged between
18-43 years with a mean of 29.7±8.8years and 15 newly
diagnosed SLE patients without renal affection, they were all
females, their ages ranged between 21- 45 years with a mean
age of 30.0 ± 10.1 years as well as 15 healthy individuals served as
a control group.
All patients were subjected to history taking, clinical
examination, laboratory investigations as CBC, ESR, CRP,
ANA, anti-dsDNA autoantibody, serum C3, C4, renal function
tests, urine analysis and renal biopsy for the LN group as well as
assessment of disease activity by SLEDAI scores.
Serum and urinary levels of TWEAKwere measured in
all patients and control by ELISA technique.
Fn14 was detected in renal biopsies from LN patients by
immunohistochemsitry.
The present study revealed:
A significantly higher serum TWEAK levels in patients
with LN than control group. While, a significantly higher
urinary TWEAK levels were found in patients with LN than non
LN and control groups.
A statistically significant difference between serum
levels of TWEAK in patients with stroke as well as positive
Summary and conclusion
(158)
antiphospholipid antibodies and those without, while there was
no statistically significant difference with other clinical
manifestations.
A statistically highly significant difference between
urinary levels of TWEAK in patients with hematuria, pyuria and
presence of casts and those without.
A significant positive correlation between serum levels
of TWEAK and ESR as well as CRP levels.
A significant negative correlation between TWEAK
levels and C3 as well as C4 levels. Also, a significant negative
correlation was noticed between urinary TWEAK levels and
anti-dsDNA titres.
A statistically high significant positive correlation
between uTWEAK and proteinuria as well as P/C ratio.
A statistically significant positive correlation between
urinary levels of TWEAK and rSLEADI as well as activity
index.
No correlation was found between serum and urinary
level of TWEAK and either age, sex or disease duration.
A statistically significant positive correlation between
Fn14 and P/C ratio.
Summary and conclusion
(159)
Non significant correlation between Fn14 and different
studied parameters.
Our study highlighted that serum TWEAK sensitivity
and specificity were 56.67% and 86.67%. While urinary
TWEAK sensitivity and specificity were 53.33% and 100%,
besides its association with rSLAEDI, urinary TWEAK with a
cut off > 20 pg/ml can be a biomarker to diagnose patients with
lupus nephritis and to detect renal disease activity.
We can conclude from these results that:
Being higher in patients with active LN, TWEAK might
play a role in the pathogenesis of the disease. In addition to its
excellent diagnostic performance for discriminating patients with
lupus nephritis from other SLE patients, it might be helpful to
predict the onset and progression of lupus nephritis in SLE patients
and to detect renal flares as well as response to treatment but
this will need further studies
Recommendations
(160)
Recommendations
1. Serial urinary TWEAK measurements in SLE patients can be
helpful to predict the onset and progression of lupus nephritis.
2. Further longitudinal larger scale studies, including more patients
are recommended to investigate the role of urinary TWEAK in
detecting flares and monitoring response to therapy in LN
patients.
3. More research is recommended to study the correlation
between the urinary TWEAK as well as Fn 14 and renal biopsy.
4. Further larger scale studies are needed to assess the
specificity of uTWEAK in LN in comparison to non lupus
renal patients and other glomerulopathies.
5. More research is needed to study the therapeutic role of
antiTWEAK in LN.
6. Further studies to assess the role of TWEAK in platelet function
and activation