The retrospective analysis of patients with Lupus Nephritis at Helen Joseph Hospital

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2021

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Qwabe, Lindokuhle Felicity

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Abstract

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with multisystem involvement. The exact aetiology remains unknown. The kidney is the most involved visceral organ in SLE and is termed Lupus Nephritis (LN). Objectives: The aim of this study is to determine the demographic profile, prevalence of LN and its histological subtypes, and to evaluate the clinical response to treatment. The study also aimed to identify common complications amongst patients with biopsy proven LN receiving immunosuppressive therapy, following up at Helen Joseph Hospital (HJH), South Africa. Methods: A retrospective analysis of patient records from 2010-2018, kept in the Renal Unit at HJH was performed. Data was collected from all files of patients with biopsy proven LN following up at the unit. Lupus Nephritis histological subtypes observed; blood and urinary laboratory results; and immunosuppressive agents used during induction and maintenance therapy phases were evaluated. Results: A total sample of 45 renal biopsies confirming LN was evaluated. This was comprised of 75.6% (n=34) females, and 24.4% (n=11) males, with a male to female ratio of 1:3.1. There was an African patient predominance of 68.9% (n=31) with a mean age of 32 years. Proliferative LN type III (26.7%), class IV (24.4%) and mixed classes accounted for (26,7%) were the most common histological subtypes observed. Induction therapy in the form of Mycophenolate Mofetil (MMF) was given in 75.5% (n=34) of patients, whilst the remaining study population received cyclophosphamide (CYC). Seventy percent (n=24) of the MMF group achieved complete remission versus 18.2% (n=2) in the CYC group over a period of six months. Twenty seven percent (n=12) of patients in the cohort developed infection during the course of their treatment. These patients commonly presented with Pulmonary Tuberculosis, Urinary Tract Infection, and skin related infections. Other complications such as gastro-intestinal disease, steroid induced diabetes and osteoporosis were also observed. Conclusion: Lupus Nephritis is a common complication seen in patients with SLE, with a strong female predominance. Most patients present with proliferative LN, warranting treatment with immunosuppressive therapy. Due to paucity of African and South African studies pertaining to LN; treatment regimens are extrapolated from European and American studies. This study aims to educate treating physicians on the clinical course of LN, and the best treatment modalities available, and their outcomes, in our South African setting

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Medicine, 2021

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