الفهرس 
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Abstract
This study aimed to assess the level of PD-L1 and TWEAK in lupus nephritis patients and find out the correlation of these markers with each others and the activity of lupus nephritis which may aid in early detection of lupus nephritis.
Subjects were classified based on (SLEDAI-2K) into:
Patient groups:
group I: included 20 active (Renal) lupus nephritis patients.
group II: included 20 active (non renal) lupus patients.
group III: included 20 inactive systemic lupus erythromatosis patients.
group IV (Control group): included 20 healthy controls.
Exclusion criteria:
Other autoimmune and collagen diseases
• Renal failure
• Diabetes
• Hypertension
• Malignancy
All subjects included in the study were subjected to the following:
1. Careful history taking.
2. Clinical Examination:
• General examination.
• Abdominal examination.
3. Radiological examination: abdominal ultrasonography.
4. Renal biopsy for active renal patients only.
5. Laboratory investigations:
A. Routine investigations:
• Blood tests;
1. complete blood count (C.B.C)
2. renal function tests
3. A.N.A.
4. Anti ds D.N.A.
5. C3,C4.
• Urine tests;
1. Simple urine analysis.
2. random urine protein creatinine ratio.
B. Special investigations:
1. PD-L1 by flow cytometry.
2. Urinary TWEAK by ELISA.
Regarding comparison between patients’ group and control group it was found that:
• There was a high statistically significant difference between groups as regard weight and sex (p<0.001), also; there was a statistically significant difference between groups as regard height where (p=0.049).
• There was no statistically significant difference between groups as regard age.
• There was statistically significant difference between groups as regard hemoglobin and hematocrit where (p<0.05).
• There was a high statistically significant difference between groups as regard PC ratio, ESR 1st and ESR 2nd hour where (p<0.001).
• There was no statistically significant difference between groups as regard RBCs count, MCV, platelet count, lymphocyte % and TLC.
• There no statistically significant difference between groups as regard blood urea and serum creatinine.
• There was a high statistically significant difference between groups as regard PD-L1 and urinary TWEAK (p<0.001).
• Also, TWEAK was significantly higher in lupus patients than in the control group (P =<0.001).
• There was a high statistically significant difference between groups as regard ANA, Anti-DNA, C3 and C4 (p<0.001).
• There was a high statistically significant difference between groups as regard urinary pus, urinary RBCs, 24-h urinary protein, urinary cast, SlEDAI score and renal SLEDAI score (p<0.001).
In group I:
• There were significant positive correlations between PD-L1 and each of ANA and P/C ratio (P = 0.007and 0.049 respectively) (r = 0.585 and 0.446 respectively).
• There were significant positive correlations between urinary TWEAK and each of blood urea, serum creatinine, urinary pus, urinary RBCs, urinary protein 24h, SLEDAI score, and renal SLEDAI score (P = 0.096,0.048, 0.006,0.002,0.016,<0.001 and <0.001 respectively) and( r = 0.382,0.446,0.593,0.66,-0.529,0.73 and 0.768 respectively).
In group II:
• There were significant positive correlations between urinary TWEAK and each of ANA, Anti-DNA, hemoglobin, hematocrit, ESR 1st hour, ESR 2nd hour, and SLEDAI score (p = .038,0.023,0.005,0.001,0.011,0.002 and 0.001 respectively) and (r = 0.466,0.505,0.603,0.677,0.558,0.648 and 0.821 respectively).
In group III;
• There were significant positive correlations between PD-L1 and each of RBCs count and ESR 1st hour (P = 0.012 ) and (r = 0.55 and 0.549 respectively), while as regard urinary TWEAK, there were significant correlations between urinary TWEAK and each of 24-h urinary protein, RBCs count and C4 ( P = 0.035 and <0.001 respectively )and (r = 0.473,-0.481 and 0.71 respectively).
In LN patients , PD-L1 in a cutoff value 11.5, has sensitivity 90%, specificity 95%,PPV 94.7%, PVN 90.4%, with AUC was 0.988, while TWEAK in a cutoff value 9.05, has sensitivity 92.5%, specificity 90%, PPV 92.2%, PVN 92.4%, with AUC was 0.985.
1. We concluded that urinary TWEAK levels and PDL-1 expression were significantly higher in patients with active LN.
2. Also, we concluded that urinary TWEAK and PDL-1 have no significant correlation to each other.
3. Urinary TWEAK and PDL-1 both are sensitive and specific for detection of LN.
Recommendations
1. Further large-scale studies are required to determine the importance of these markers in follow-up of lupus nephritis patients.
2. Further large-scale studies are needed to investigate their possible use as a marker for prognosis of lupus nephritis Activity.
3. Further studies are needed to assess whether they may aid in assessment of the effectiveness of lupus nephritis treatments.