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Baraka E, Hashaad N, Abdelhalim W, Elolemy G. Serum cystatin C and βeta-2 microglobulin as potential biomarkers in children with lupus nephritis. Arch Rheumatol 2023; 38:56-66. [DOI: 10.46497/archrheumatol.2023.8520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/29/2020] [Indexed: 03/18/2023] Open
Abstract
Objectives: In this study, we aimed to assess serum levels of Cystatin C (Cys C) and beta-2 microglobulin (β2M) in juvenile systemic lupus erythematosus (JSLE) patients and to investigate their role as potential biomarkers of lupus nephritis (LN) and overall disease activity.
Patients and methods: Between December 2018 and November 2019, a total of 40 patients with JSLE (11 males, 29 females; mean age: 12.6±2.5 years; range, 7.5 to 16 years) and 40 age- and sex-matched controls (10 males, 30 females; mean age: 12.3±2.4 years; range, 7 to 16 years) were included in this study. Serum (s) Cys C and β2M levels were compared between the groups. The SLE Disease Activity Index (SLEDAI-2K), the renal SLEDAI (rSLEDAI), and the Renal Damage Index were used.
Results: JSLE patients had significantly elevated mean sCyc C and sβ2M levels (1.4±0.8 mg/mL and 2.8±0.9 mg/mL, respectively) compared to the controls (0.6±0.1 mg/mL and 2.0±0.2 mg/mL, respectively; p<0.00). The mean sCys C and sβ2M levels were significantly higher in the LN group, compared to non-LN patients (1.8±0.7 mg/mL and 3.1±1.0 mg/mL, respectively vs. 0.8±0.3 mg/mL and 2.4±0.6 mg/mL, respectively; p=0.002 and p=0.02, respectively). The sCys C levels had significant positive correlations with erythrocyte sedimentation rate (r=0.3, p=0.05), serum creatinine (r=0.41, p= 0.007), 24-h urinary protein (r=0.58, p<0.001), anti-double stranded deoxyribonucleic acid antibodies titers (r=0.55, p=0.002), extra-renal SLEDAI scores (r=0.36, p=0.04), rSLEDAI (r=0.46, p=0.002), and renal class (r=0.7, p=0.0001). Serum β2M levels were significantly negatively correlated with complement 4 levels (r=-0.31, p=0.04) and significantly positively correlated with extra-renal SLEDAI scores (r=0.3, p=0.05).
Conclusion: These findings confirm that sCys C and sβ2M levels are increased in JSLE patients in association with the overall active disease. However, sCys C level may act as a promising non-invasive biomarker for predicting kidney disease activity and biopsy classes in children with JSLE.
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Szymanik-Grzelak H, Barabasz M, Wikiera-Magott I, Banaszak B, Wieczorkiewicz-Płaza A, Bieniaś B, Drożynska-Duklas M, Tkaczyk M, Pańczyk-Tomaszewska M. Retrospective analysis of clinical and pathomorphological features of lupus nephritis in children. Adv Med Sci 2021; 66:128-137. [PMID: 33545446 DOI: 10.1016/j.advms.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/08/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the study was to evaluate the clinical course and pathomorphological correlations in Polish children with the diagnosis of lupus nephritis (LN). METHODS We retrospectively analyzed the medical records of 39 children hospitalized due to LN in 7 pediatric nephrology units in Poland between 2010 and 2019. Demographic data, clinical symptoms at the onset of LN and laboratory parameters were reviewed. We analyzed Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), histological LN findings with the activity (IA) and chronicity index (IC). RESULTS We examined 32 girls and 7 boys, median age at LN onset was 14.75 (IQR 13.0-16.0) years, SLEDAI of 22.0 (IQR 18.0-27.0) points; LN histological class: IV (59.4%), III (18.9%), III/V (10.8%), IV/V (8.1%), VI (2.7%); IA 8.0 (IQR 6.0-11.0) points, IC 1.05 (IQR 0-2.0) points. Children with nephrotic (n = 22) and non-nephrotic (n = 17) proteinuria differed in median Hb level (9.55, IQR 8.3-11.2 vs 10.9, IQR 10.1-11.6 g/L; P < 0.05), albumin level (2.5, IQR 2.1-3.19 vs 3.6, IQR 3.4-4.1 g/dL; P < 0.001), proteinuria (5.76, IQR 3.0-7.5 vs 1.08, IQR 0.53-1.50 g/day; P < 0.0001), eGFR (53.9, IQR 27.0-68.8 vs 96.7, IQR 73.8-106.2 mL/min/1.73 m2; P < 0.01) and occurrence of hypertension (77% vs 23%; P < 0.01). In multivariate analysis Hb level (β = 8.0; 95%CI, 1.90-14.11) was the significant predictor of eGFR<90 mL/min/1.73 m2. CONCLUSIONS Proliferative forms of LN in children may have a varying clinical presentation. Children with LN with nephrotic range proteinuria have lower Hb level, lower eGFR and higher occurrence of hypertension. Hb level is the significant predictor of eGFR<90 mL/min/1.73 m2 in children with LN.
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De Rosa M, Rocha AS, De Rosa G, Dubinsky D, Almaani SJ, Rovin BH. Low-Grade Proteinuria Does Not Exclude Significant Kidney Injury in Lupus Nephritis. Kidney Int Rep 2020; 5:1066-1068. [PMID: 32647764 PMCID: PMC7335958 DOI: 10.1016/j.ekir.2020.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Marcelo De Rosa
- Hospital de Clinicas, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | | | - Graciela De Rosa
- Hospital de Clinicas, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Diana Dubinsky
- Hospital de Clinicas, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Salem J Almaani
- Division of Nephrology, The Ohio State University, Columbus, Ohio, USA
| | - Brad H Rovin
- Division of Nephrology, The Ohio State University, Columbus, Ohio, USA
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Shamim R, Farman S, Batool S, Khan SEA, Raja MKH. Association of systemic lupus erythematosus disease activity index score with clinical and laboratory parameters in pediatric onset systemic lupus erythematosus. Pak J Med Sci 2020; 36:467-472. [PMID: 32292454 PMCID: PMC7150399 DOI: 10.12669/pjms.36.3.1480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: To determine the association of systemic lupus erythematosus disease activity index (SLEDAI) score in pediatric onset SLE (p-SLE) with clinical and laboratory parameters. Methods: This cross sectional observational study was conducted at Division of Rheumatology, Fatima Memorial Hospital, Lahore from November 2018 to January 2019. Total 23 patients diagnosed with p-SLE having onset of symptoms at ≤ 18 years of age, irrespective of their current age at presentation, of either gender, fulfilling criteria of 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria were enrolled. Patients’ clinical symptoms and laboratory parameters were reviewed, SLEDAI scores were calculated. Collected Data were entered in proforma and analyzed on SPSS version 23. Results: There were 91.3% females. Mean age at diagnosis was 11years ± 4years. At presentation patients had hematological involvement 69.6% followed by mucocutaneous symptoms 65.2% and renal involvement 21.6%. ANA by IFA was positive in all, while anti-ds-DNA was positive in 78.3% patients. SLEDAI score was ≥6 in 87% patients, average SLEDAI score was higher in patients with renal involvement (p=0.06). Elevated ESR (r=0.48, p=0.02), Anti-dsDNA (r=0.44, p=0.05) and low complement levels (p=0.03) were significantly positively correlated, while hemoglobin (r= -0.43, p=0.04) was negatively correlated with the SLEDAI score. Conclusion: In this study, patients with Lupus Nephritis had high SLEDAI scores. Elevated Anti-dsDNA titer, ESR, low complement levels and hemoglobin were significantly associated with high SLEDAI scores. We recommend that SLEDAI score should be calculated in p-SLE patients for stringent disease monitoring and treatment.
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Affiliation(s)
- Roshila Shamim
- Roshila Shamim, FCPS (Medicine). Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Sumaira Farman
- Sumaira Farman, FRCP, FACP, FACR, SCE Rheumatology. Graduate Certificate Paediatric Rheumatology, Dept. of Rheumatology, National Hospital and Medical Centre, Lahore, Pakistan
| | - Shabnam Batool
- Shabnam Batool, FCPS (Rheumatology), FCPS (Medicine). Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Saira Elaine Anwer Khan
- Saira Elaine Anwer Khan, MRCP, SCE Rheumatology. Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
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Putera AM, Irwanto I, Maramis MM, Prasetyo RV, Soemyarso NA, Noer MS. Effect of Mental Health Problems on the Quality of Life in Children with Lupus Nephritis. Neuropsychiatr Dis Treat 2020; 16:1583-1593. [PMID: 32617005 PMCID: PMC7326200 DOI: 10.2147/ndt.s250373] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Mental health problems, such as anxiety, depression, and ineffective family coping, in children with lupus nephritis (LN) can increase the severity and affect the management of the disease, thus affecting the quality of life (QoL) of patients. OBJECTIVE Analyzing the association between levels of depression, anxiety, coping, disease activity on the QoL of pediatric patients with LN. PATIENTS AND METHODS There were 62 pediatric LN participants (16 participants in the induction phase and 46 participants in the maintenance phase). Participants were measured for anxiety, depression, coping, disease activity (systemic lupus erythematosus disease activity index/SLEDAI), and QoL. The measurement results were compared between induction and maintenance groups. Analysis of the association between anxiety, depression, coping, and disease activity with the QoL of children with LN used a multiple logistic regression test with p <0.05. RESULTS The measurement results obtained anxiety (induction = 69.06±3.92 and maintenance = 45.24±10.33; p <0.001), depression (induction = 69.88±3.34 and maintenance = 42.20±9.12; p <0.001), coping (induction = 99.88±12.93 and maintenance = 115.67±7.34; p <0.001), SLEDAI (induction = 15.81±12.58 and maintenance = 0.43±1.26; p <0.001), and QoL (induction = 49.92±12.44 and maintenance = 88.15±8.06; p <0.001).. Anxiety level in the induction group (p = 0.043) and maintenance group (p <0.001; p = 0.032; p = 0.008; p = 0.009). Depression level in the induction group (p = 0.031) and maintenance group (p = 0.024; p = 0.042; p = 0.003). SLEDAI score in the maintenance group (p = 0.003; p = 0.003). Coping in induction group (p = 0.016; p = 0.016) and maintenance group (p = 0.005). CONCLUSION Mental health disorders reduce the QoL of LN children, and the level of QoL in induction phase is lower than maintenance phase.
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Affiliation(s)
- Azwin Mengindra Putera
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Irwanto Irwanto
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Margarita Maria Maramis
- Department of Psychiatry, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Risky Vitria Prasetyo
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ninik Asmaningsih Soemyarso
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Mohammad Sjaifullah Noer
- Department of Child Health, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Samanta M, Nandi M, Mondal R, Hazra A, Sarkar S, Sabui T, Kundu CK, Biswas A. Childhood lupus nephritis: 12 years of experience from a developing country's perspective. Eur J Rheumatol 2017; 4:178-183. [PMID: 29163999 DOI: 10.5152/eurjrheum.2017.16117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/12/2017] [Indexed: 12/18/2022] Open
Abstract
Objective To assess the long-term outcome of lupus nephritis in children with systemic lupus erythematosus followed up over 12 years at a tertiary care teaching hospital in Eastern India. Material and Methods This is a retrospective observational study of the clinicopathological presentation, management, and outcome in 46 children with lupus nephritis over a period of 12 years at a tertiary teaching hospital in Eastern India. Mortality was compared between different lupus classes and therapy groups with Kaplan-Meier analysis and log-rank test. Results The incidence of lupus nephritis was 58.97% [95% confidence interval (CI) 48.06%-59.89%] with the mean age at presentation being 10.2±2.43 years (range 5.5-14.5) years. Majority belonged to class IV (30.43%), followed by class II (26.91%), class III (23.91), and class V (8.70%). Outcome analysis of children with lupus nephritis over 12 years revealed that 24 (52.17%) achieved complete remission of disease activity, 5 attained partial remission, 4 continued to have active disease, 5 developed end-stage renal disease (ESRD), and 8 died. Overall mortality thus observed was 17.39% with septicemia in the background of ESRD being the commonest cause. No significant difference in mortality was observed between different lupus nephritis classes or therapy arm groups. Conclusion The study throws light on various aspects of lupus nephritis and their long-term outcome patterns in children from developing countries such as India.
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Affiliation(s)
- Moumita Samanta
- Department of Pediatrics, NRS Medical College, Kolkata, India
| | - Madhumita Nandi
- Department of Pediatrics, NRS Medical College, Kolkata, India
| | - Rakesh Mondal
- Department of Pediatrics, Medical College and Hospital, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, IPGME&R SSKM Hospital, Kolkata, India
| | - Sumatra Sarkar
- Department of Pediatrics, IPGME&R SSKM Hospital, Kolkata, India
| | - Tapas Sabui
- Department of Pediatrics, RGKAR Medical College, Kolkata, India
| | | | - Arnab Biswas
- Department of Pediatrics, NRS Medical College, Kolkata, India
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Skrzypczyk P, Przychodzień J, Mizerska-Wasiak M, Kuźma-Mroczkowska E, Okarska-Napierała M, Górska E, Stelmaszczyk-Emmel A, Demkow U, Pańczyk-Tomaszewska M. Renalase in Children with Glomerular Kidney Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1021:81-92. [PMID: 28405891 DOI: 10.1007/5584_2017_22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Studies suggest that renalase, a renal catecholamine-inactivating enzyme, plays a major role in the pathogenesis of kidney and cardiovascular diseases in adults. This study seeks to determine the role of renalase in children with glomerular kidney diseases. We evaluated the serum renalase, arterial stiffness, intima-media thickness, blood pressure, and clinical and biochemical parameters in 78 children (11.9 ± 4.6 years of age) with glomerulopathies such as idiopathic nephrotic syndrome (40 cases), IgA nephropathy (12 cases), Henoch-Schönlein nephropathy (12 cases), and other glomerulopathies (14 cases). The control group consisted of 38 healthy children aged 11.8 ± 3.3 years. The mean renalase was 25.74 ± 8.94 μg/mL in the glomerulopathy group, which was not significantly different from the 27.22 ± 5.15 in the control group. The renalase level did not differ among various glomerulopathies either. However, proteinuric patients had a higher renalase level than those without proteinuria (28.43 ± 11.71 vs. 24.05 ± 6.23, respectively; p = 0.03). In proteinuric patients, renalase correlated with daily proteinuria. In the entire glomerulopathy group, renalase correlated with age, systolic central blood pressure (BP), diastolic peripheral and central BP, mean peripheral and central BP; peripheral diastolic BP Z-score, glomerular filtration rate, cholesterol, triglycerides, and pulse wave velocity. We conclude that in children with glomerulopathies renalase, although basically not enhanced, may underlie blood pressure elevation and arterial damage.
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Affiliation(s)
- Piotr Skrzypczyk
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland.
| | - Joanna Przychodzień
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | - Małgorzata Mizerska-Wasiak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | - Elżbieta Kuźma-Mroczkowska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | | | - Elżbieta Górska
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Anna Stelmaszczyk-Emmel
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Pańczyk-Tomaszewska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
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