LUPUS NEPHRITIS

CATEGORIZATION OF PROTEINURIA AND HEMATURIA IN PATIENTS WITH LUPUS NEPHRITIS AT A TERTIARY CARE CENTER IN LAHORE.

Abstract

Categorization of proteinuria and hematuria in patients with lupus nephritis at a
tertiary care center Lahore. Objectives: Distribution of proteinuria and hematuria has a pivotal
role in renal complications of systemic lupus erythematosus (SLE). Proteinuria and hematuria
has been included as an independent descriptor in the SLE disease activity index (SLEDAI).
Hence this study aims to categorize the proteinuria and hematuria in local population. Data
Source: Fatima Memorial Hospital. Design of Study: Descriptive study. Setting: This study
was conducted in the Department of Morbid Anatomy and Histopathology, at University of
Health Sciences, Lahore. Samples were collected from the department of pathology at Fatima
Memorial Hospital Lahore. Period: In 2015 from January till December. Methods: Urine was
collected from 38 cases both male and female patients immediately prior to biopsy for evaluation
of lupus nephritis. Relevant laboratory investigations, serum Antinuclear antibody (ANA) and
Anti-double stranded DNA (Anti dsDNA) levels and renal function tests were recorded. The
proteinuria and hematuria were detected and categorized by dipstick methods. Proteinuria was
categorized on the following scale: 1+ = 200 - 500 mg/24 hours, 2+ = 500 - 1500 mg/24
hours, 3+ = 2500-3500 mg/24 hours and 4+ = >3500 mg/24 hours. Microscopic hematuria
is categorized via RBC/HPF: 0–2 (negative), 3–10 (1+), 11–50 (2+), 51–100 (3+), and 100+
(4+). Microscopic hematuria was categorized as RBC/HPF: 0–2 (negative), 3–10 (1+), 11–50
(2+), 51–100 (3+), and 100+ (4+). Results: Among 38 patients the male to female ratio was
1:5. Mean age of the patients was 26.55 ± 8.13 years with age range of 14-49 years. A total of
37 (97.3 %) cases had proteinuria. The intensity of proteinuria was graded as 1+ in 4 (10.53%),
2+ in 14 (36.84%) and 3+ in 19 (50%) patients. Haematuria was present in 31 (81.58%) cases.
Among these patients, the intensity was graded as 1+ in 11 (28.95%), 2+ in 9 (23.68 %) and
3+ in 11 (28.95%) cases. Serum ANA and anti dsDNA were positive in all cases regardless of
disease progression. None of the variable showed any significant association when compared
statistically. Conclusions: The grade of proteinuria increases rapidly with progression of the
lupus nephritis in SLE which may be partly due to delayed diagnosis and brisk activity of the
renal flares and partly as complication in SLE treatment in our population. Hematuria in the
presence of proteinuria alone can suggest glomerular disease progression without the need for
extensive urological investigations.