الفهرس 
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Abstract
This study was carried out in department of internal Medicine, Minia University Hospital along period between March 2019 and March 2021.
The study aimed to detect the relation of urinary vascular cell adhesion molecule-1(VCAM-1), urinary Monocyte chemoattractant protein-1(MCP-1) and urinary NGAL to lupus nephritis activity and the link between autoimmune thyroid disease with SLE and LN patients.
Detect the relation of serum Insulin-like Growth Factor Binding Protein- 4 (IGFBP-4) with nephritis chronicity index.
Two hundred and five patients (205) were involved in this study, divided in three groups:
group I: It involved 85 cases SLE with lupus nephritis (LN) that was divided into two subgroups according to L.N activity:
Active lupus nephritis (LN) :
All had biopsy proven LN with their urine collection for the study done concomitantly with the renal biopsy. In our study, active LN patients were 45 in number.
Inactive LN: were in complete remission state with their urine collection for the study (proteinuria less than 300mg / 24hrs, inactive urinary sediment) after six months of induction therapy. In our study, inactive L.N patients were 40 in number.
group II: It included 80 patients SLE without nephritis that was divided into two subgroups according to SLE activity:
Active non renal SLE:
Those having a SLEDAI score higher than zero, but a renal SLEDAI score of 0, in our study, active non-renal SLE patients were 40 in number.
inactive SLE:
Those having a clinical SLEDAI score of zero with no evidence of renal activity before or At the period of their clinic visit. In our study, inactive SLE patients were 40 in number.
group III (chronic group):
It included 25 patients with chronic lupus nephritis.
In addition, 15 patients with other chronic renal diseases
Referred to as chronic Kidney Disease (CKD) as:
Focal Segmental Glomerulosclerosis (FSGS), Membranous nephropathy, hypertensive nephropathy and chronic interstitial nephritis)) were recruited as disease controls for chronic L.N patients.
All the study subjects were submitted to:
- Thorough clinical history.
- Carful clinical evaluation.
- Laboratory investigations: complete blood count, liver function tests ,renal function tests ,prothrombin time, urine analysis ,24hr urinary protein,viral markers , Serum markers of inflammation (ESR &CRP)
ANA, anti-ds DNA antibodies, serum Complement (C 3, C4) and Thyroid function test (TSH, free T3, T4, anti-thyroglobulin antibodies, anti-thyroid peroxidase antibodies)
Specific investigation: urinary (VCAM-1), urinary MCP1 with urinary NGAL and serum Insulin-like Growth Factor Binding Protein 4 (IGFBP4).
Radiological assessment:
-Abdominal ultrasonography.
-Superficial thyroid ultrasound.
- Renal biopsy for active lupus nephritis patients and number of chronic group.
In first part of our study all patients in group I and group II were investigated for three urinary biomarkers (uVACM-1, uMCP-1 and uNGAL), thyroid function test and autoimmune thyroid antibodies and we observed substantial variance between the 3 groups in the levels of our studied urine biomarker levels in favor of the active LN group.
The three biomarkers showed significant associations with the total SLEDAI score, in addition to the renal SLEDAI scores. We also performed AUC analysis to test the ability of the urine biomarkers to predict LN activity and three biomarkers can discriminate among active LN cases and other groups of SLE.
Three biomarkers significant correlations with activity index of L.N in histopathology study of renal biopsy while uMCP-1 the levels were significantly greater in cases with proliferative changes (stage III and IV) which can help in predication of L.N class in renal biopsy.
uNGAL and uMCP-1 correlated mildly to chronicity index and serum creatinine which may help together in early detection of disease progression of L.N.
In the other hand of our study we demonstrated that serum IGFBP-4 considerably high in chronic LN patients than cases with other chronic renal diseases and can discriminate chronicity of lupus nephritis from chronicity of other chronic renal diseases, with sensitivity = 88%, specificity = 90.5% and its levels had astrong positive association with chronicity index.
In the last part of our study we foud that subclinical and overt hypothyroidism is common in cases with SLE.
SLE cases with LN had considerably greater thyroid autoantibodies than SLE cases without nephritis.
Thyroid autoantibodies were significantly correlated to 24hrs urinary proteins, s.Cr and eGFR which related to severity of renal affection in SLE patients.
Conclusion
Urinary levels of VCAM-1, MCP-1 and NGAL serve as better biomarkers in predicting lupus nephritis activity compared to conventional serum and urine metrics.
Serum IGFBP-4 can use as a biomarker for indicative of chronicity changes in LN.
Hypothyroidism, both subclinical and overt, is frequent in lupus patients.
Thyroid autoantibodies were considerably elevated in LN cases compared to SLE cases without nephritis.