Non-renal Disease Activity Research Articles

Serum Adiponectin Level in Patients with Systemic Lupus Erythematosus and its Correlation with Disease Activity

Background: Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disorder characterised by widespread inflammation of connective tissues affecting the skin, joints, kidneys, heart, lungs, and nervous system. SLE is associated with significant morbidity, thus requiring prompt evaluation, appropriate therapy and long-term follow-up. Objective: This study was performed to measure serum adiponectin in SLE patients and to correlate it with SLEDAI and to evaluate its role as a biomarker of activity in SLE patients specially renal in the hope of preventing or at least postponing renal damage. Patients and methods: This study included 72 subjects, 36 patients and 36 volunteers. The patients were divided into three groups. Group I (active renal) 12 patients having renal disease activity, group II (active non-renal) 12 patients having non-renal disease activity and group III (inactive SLE). 36 apparently healthy volunteers were included (group IV) as a control group. Results: A highly significant difference in serum adiponectin between SLE groups and control group. A highly significant positive correlation between serum adiponectin and 24 h protein in urine. Negative correlation between serum adiponectin and C3 & C4. A significant difference between SLE groups as regards serum anti-double stranded DNA titres, which were higher in renal group patients, also C3 & C4 levels which were lower in the renal group. Serum adiponectin level was not correlated with SLE Disease Activity Index (DAI). Conclusion: Adiponectin level was strongly associated with active SLE with renal disease. Adiponectin level in SLE patients was not correlated with SLEDAI. It may be a promising biomarker for prediction of renal activity of SLE.

Serum Adiponectin Level in Patients with Systemic Lupus Erythematosus and its Correlation with Disease Activity

Background: Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disorder characterised by widespread inflammation of connective tissues affecting the skin, joints, kidneys, heart, lungs, and nervous system. SLE is associated with significant morbidity, thus requiring prompt evaluation, appropriate therapy and long-term follow-up. Objective: This study was performed to measure serum adiponectin in SLE patients and to correlate it with SLEDAI and to evaluate its role as a biomarker of activity in SLE patients specially renal in the hope of preventing or at least postponing renal damage. Patients and methods: This study included 72 subjects, 36 patients and 36 volunteers. The patients were divided into three groups. Group I (active renal) 12 patients having renal disease activity, group II (active non-renal) 12 patients having non-renal disease activity and group III (inactive SLE). 36 apparently healthy volunteers were included (group IV) as a control group. Results: A highly significant difference in serum adiponectin between SLE groups and control group. A highly significant positive correlation between serum adiponectin and 24 h protein in urine. Negative correlation between serum adiponectin and C3 & C4. A significant difference between SLE groups as regards serum anti-double stranded DNA titres, which were higher in renal group patients, also C3 & C4 levels which were lower in the renal group. Serum adiponectin level was not correlated with SLE Disease Activity Index (DAI). Conclusion: Adiponectin level was strongly associated with active SLE with renal disease. Adiponectin level in SLE patients was not correlated with SLEDAI. It may be a promising biomarker for prediction of renal activity of SLE.

FRI0295 Urinary tweak predicts renal disease activity in patients with systemic lupus erythematosus over a 1 year period

BackgroundTNF-like weak inducer of apoptosis (TWEAK) is a member of the TNF superfamily that signals through its distinct, highly inducible receptor, FGF-inducible molecule 14 (Fn14) on renal epithelial and mesenchymal...

Isolated pyuria in systemic lupus erythematosus

The objective of this study was to assess isolated pyuria in an unselected systemic lupus erythematosus sample, and to determine factors potentially associated with this manifestation. We studied patients followed in our lupus clinic, defining isolated pyuria as more than 10 white blood cells per high power field in the absence of hematuria, proteinuria, casts, or bacteriuria. We assessed the effects of various demographic and clinical factors on the occurrence of isolated pyuria, using univariate logistic regression analyses. We also performed multivariate models which included sex, age, race/ethnicity, systemic lupus erythematosus duration, non-renal systemic lupus erythematosus disease activity, systemic lupus erythematosus damage, number of non-renal and renal American College of Rheumatology criteria ever present, pre-existing hypertension, and current drug exposures. Of 264 subjects, 66 were excluded (43 had bacteriuria or a contaminated urine culture and 23 had no concomitant urine culture); 27 of the remaining 198 (13.6%) had isolated pyuria. Sixteen of 27 patients with sterile pyuria had previous American College of Rheumatology criteria for renal involvement (hematuria, casts, and/or proteinuria) compared to 62/171 patients without sterile pyuria (unadjusted odds ratio = 2.55; 95% confidence interval = 1.11-5.85). Our univariate analyses also suggested a trend towards higher non-renal disease activity in patients with isolated pyuria. Independent associations were not evident in adjusted analyses. Isolated pyuria was observed in a significant number of our systemic lupus erythematosus sample. Although the differential diagnosis for isolated pyuria is broad, this manifestation may be correlated with lupus activity even in the absence of hematuria or proteinuria. Lupus (2010) 19, 793-796.

The Relationship Between Renal Activity and Quality of Life in Systemic Lupus Erythematosus

To evaluate the relationship between renal activity and quality of life (QOL) in patients with systemic lupus erythematosus (SLE). Three hundred eighty-six patients completed annual Medical Outcomes Study Short Form-36 questionnaires and physicians completed the SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. Concurrent association between renal activity and QOL was evaluated through regression models that adjusted for demographics and nonrenal disease activity and nonrenal damage. To characterize the longitudinal relationship between change in renal activity and change in QOL, all renal activity and QOL data over the entire study were used to estimate a linear trend within each individual patient through hierarchical modeling. In the regression model that assessed the association between renal activity and QOL, on average, each additional renal activity item fulfilled was associated with a 2.04-unit (95% CI 0.88, 3.24) decrease in the physical function subscale, a 5.28-unit (95% CI 2.76, 7.76) decrease in the role-physical subscale, a 2.24-unit (95% CI 0.72, 3.80) decrease in the social function subscale, and a 1.16-unit (95% CI 0.60, 1.72) decrease in the physical component summary score. In the hierarchical model, no association was observed between changes in renal activity and QOL. Patients with SLE and active renal disease concurrently experience a slightly poorer QOL than those without renal disease, especially in the physical domains. Because the confidence intervals were wide, we could not accurately estimate whether a longitudinal change in renal activity was associated with a change in QOL.

Significance of isolated hematuria and isolated pyuria in systemic lupus erythematosus

Hematuria or sterile pyuria as isolated urinary findings present a clinical dilemma for the treating physician. Our objective was to determine whether isolated hematuria and isolated sterile pyuria are associated with active systemic lupus erythematosus (SLE) with respect to renal and non-renal disease activity. This is a descriptive study from a large SLE cohort followed prospectively at the University of Toronto Lupus Clinic. All episodes of isolated hematuria and isolated pyuria between 1970 and 2000 were identified from our database. Isolated hematuria was defined as > 5 red blood cells per high power field; isolated sterile pyuria was defined as > 5 white blood cells per high power field in the absence of urinary infection and other renal manifestations. Non-renal disease activity (defined as nrSLEDAI > 1) was determined at first episode of isolated hematuria and pyuria. Renal disease activity was assessed by scoring renal biopsies within 3 months of detecting isolated hematuria or sterile pyuria. Thirty-four percent (323/946) of our cohort had at least one episode of isolated hematuria. Seventy-seven percent of these patients had concurrent non-renal disease activity. Of the 22 biopsies scored with isolated hematuria, 96% were abnormal (WHO > class I), including 52% with active nephritis. Twenty-three percent (215/946) had at least one episode of isolated sterile pyuria. Seventy-eight percent of these patients had concurrent non-renal disease activity. All 12 biopsies scored with isolated pyuria were abnormal (WHO Class > 1), including 75% with active nephritis. The appearance of isolated hematuria and isolated pyuria is associated with active renal and non-renal disease activity. An ongoing debate has emerged regarding the significance of isolated hematuria and isolated pyuria with respect to SLE disease activity. The results of this study suggest that isolated hematuria and isolated pyuria is associated with active renal and non-renal disease activity. Thus isolated hematuria and isolated sterile pyuria should be considered manifestations of active SLE.