الفهرس 
Systemic Lupus ErythematosusOnly 14 pages are availabe for public view
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Abstract
Rheumatic diseases are a group of multisystem chronic inflammatory disorders that involve multiple body systems; not only the musculoskeletal, and therefore exhibit a wide spectrum of clinical manifestations. In the absence of reliable serological markers, accurate clinical tools are required to assess disease activity and damage for treatment decisions.
The kidney may be affected in various Rheumatological disorders in these diseases the kidney may be affected in different forms such as glomeruloneritis , renal vascular disease or interstitial nepritis , leading to impairment of renal function. Diagnosis of these diseases depend on the clinical picture , laboratory investigations and / or histopathological examination of renal biopsy or biopsies taken from different lesion forms.
The clinical picture differs accordingly, this is dependant on the degree of renal affection and whether other systems of the body are affected or not. In cases of renal affection , most patient have one or more of the following :
Hypertension,Proteinuria (miled ,moderate or heavy),Heamaturia.Elevated serume creatinine and /or Decreased creatinine clearance. In addition to manifestation of other organs involvement . In cases of sever renal affection , the patients are coming by manifestations of end stage renal disease.
Laboratory investigations play an important role in diagnosis of autoimmune diseases and renal affection. This usually depends on detection of auto antibodies in the patient`s serum such as ANA , ANCA , Anti double stranded DNA antibodies and Anti smooth muscle antibodies. Also evaluation of the serum complements , serum creatinine , blood urea , creatinine clearance , complete urine analysis , 24 hours urinary proteins are helpful for diagnosis and evaluation of prognosis of renal condition in patients on treatment.
Renal imaging by ultra sound (u/s) , Doppler doplex on renal vasculature , real CT imaging and renal angiography also play a role in diagnosis of certain diseases such as polyarteritis nodosa.
Renal biopsy: Histopathological examination of renal biopsy is one of the most important investigatins whether for diagnosis or evaluation of prognosis in patients on treatment . Renal biopsy can be examined by light microscopy , electron microscopy or immunoflourescence which has a benifit rol in detection of immune complex deposition in renal tissue .
Treatment of renal affection in rheumatic diseases is different according to the degree of renal impairment , Goals of treatment include :
(1) To achieve prompt renal remission.
(2) To avoid renal flares.
(3) To avoid chronic renal impairment.
(4) To fulfill these objectives with minimal toxicity.
Although patient and renal survival rates have improved over the past decade , immunosuppressive regimens still achieve suboptimal results & treatment-related toxicity remains a major concern.
Renal replacement therapy is a line of treatment in end stage renal disease. Autologous Stem Cell Transplantationis still under trial for treatment of renal affection in auto immune diseases.
Renal transplantation is a line of therapy although recurrence of autoimmune glomerulonephritis has been reported in some cases after renal transplantation.