CLINICAL AND HISTOPATHOLOGICAL CHARACTERIZATION OF LUPUS NEPHRITIS IN A TERTIARY HEALTH CENTRE, NORTH-EASTERN NIGERIA: REPORT OF FIVE CASES.

Sulaiman Mm, ,Yerima A,Pindiga Uh,Rheumatology Unit, Department Of Medicine, University Of Maiduguri Teaching Hospital ,Zarami Ab,Department Of Histopathology, College Of Medical Sciences, University Of Maiduguri ,Lawan M

doi:10.36020/kjms.2021.1501.009

Abstract

Background: Lupus nephritis (LN) is an immune complex glomerulonephritis that complicates up to 40% of SLE patients. A kidney biopsy is required for diagnosis and staging of the disease. Case report: We report a cohort of five patients with LN from a tertiary health facility in northeastern Nigeria. The five patients were all women with age ranging from 26 to 55 years, and eGFR of between 6 to 154ml/minute. Four patients had normal kidney size and were biopsied whereas 1 patient had contracted kidney. Diffuse proliferative LN (Class IV) was seen in two patients while the other two patients had glomerular sclerosis (Class VI). Patients were given induction with methylprednisolone and mycophenolate mofetil (MMF). At one year follow up 2(40%) patients were in remission, 1(20%) was on maintenance hemodialysis and 2(40%) patients had died. Conclusion: Lupus nephritis is a common complication of SLE in northeastern Nigeria. Patients have features of advanced kidney disease at presentation.

Highlights

Lupus nephritis (LN) is an immune complex glomerulonephritis that develops as one of the severe organ manifestation of systemic lupus erythematosus (SLE) with ample morbidity and mortality
We report the clinical and renal histopathologic findings in five patients managed for LN in UMTH Maiduguri, Nigeria
Two (40%) died during treatment of which one was in Class IV and the other in class V. (Table 1)

Summary

INTRODUCTION

Lupus nephritis (LN) is an immune complex glomerulonephritis that develops as one of the severe organ manifestation of systemic lupus erythematosus (SLE) with ample morbidity and mortality. Some patients will present with 'silent' LN (normal renal function and urinalysis), severe proteinuria (nephrotic syndrome), acute nephritic syndrome and/or acute kidney failure. Despite the reports on the increased disease severity of LN among Blacks and African Americans, there are few reports of biopsy-proven lupus nephritis in Nigeria. Diagnosis of LN in developing countries is challenging due to delay in patients' presentation, lack of reliability of clinical features alone, difficulties performing biopsies, poor correlation between histopathologic and clinical features of the disease; and where biopsies are performed, there are difficulties in differentiating LN from overlapping conditions such as thrombotic microangiopathy, non-steroidal anti-inflammatory drugs (NSAIDs) interstitial nephritis, focal segmental glomerulosclerosis from other causes, and IgA nephropathy.[12]. We report the clinical and renal histopathologic findings in five patients managed for LN in UMTH Maiduguri, Nigeria

RESULTS

DISCUSSION

CONCLUSION