الفهرس 
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Abstract
Background: Lupus nephritis is one of the most serious manifestations of systemic lupus erythematosus (SLE). Novel biomarkers are necessary to enhance the diagnostic accuracy and sensitivity of lupus nephritis (LN).
Aim of the work:To clarify the value of serum adiponectin and urinary adiponectin/creatinine ratio as markers for inflammatory pattern of lupus nephritis and their relation to insulin resistance and disease activity.
Subjects and methods:The serum concentrations of adiponectin and urinary adiponectin/ creatinine ratio were determined in 30 female patients with SLE (14 with and 16 without LN) and 21 sex- and age-matched control subjects by enzyme linked immunosorbent assay and correlated with the SLE disease activityusing the Systemic Lupus Erythmatosus Disease Activity Index (SLEDAI). Body mass index (BMI), systolic and diastolic blood pressure, complete blood count, liver functions, serum creatinine, estimated glomerular filtration rate, urine analysis, urinary protein,erythrocyte sedimentation rate (ESR), C reactive protein, ANA, anti- ds DNA, C3, C4, fasting insulin and glucose, HOMA-IR, plasma lipid profile, were determined.All patients with lupus nephritis were further classified according to renal biopsy into 6 patients with inflammatory (class IIIand IV) and 8 patients with non inflammatory (class I,II and V)pattern of LN.
Results: Serum adiponectin levels were higher in SLE patientsthan controls and in patients with inflammatory LN than patients with non inflammatoryLN (P= 0.002 and 0.01respectively).Urinary adiponectin/creatinine ratio levels were also higher in inflammatory LN than non inflammatory LN or controls (P=0.03 and 0.004 respectively). There was significant increase in HOMA-IR in SLE patients when compared to controls (P=0.03).There was a significant negative correlation between serum adiponectin and HOMA-IR in SLE patients (r=-0.44, P=0.015), while it showed no significant correlation with SLEDAI (P=0.4). On the other hand there were no correlations between urinary adiponectin/creatinine ratio and both SLEDAI and HOMA-IR (P=0.26 and 0.13 respectively).
Elevated levels of adiponectin in SLE, together with inverse correlation with HOMA-IR, suggest its possible involvement in IR.
Conclusion:Serum adiponectin and urinary adiponectin/creatinine ratio were elevated in inflammatory LN and might have a role in the pathology of LN. Urine adiponectin/creatinine ratio might be a biomarker for inflammatory LN.
Abbreviations: SLEDAI, Systemic Lupus Erythematosus Disease Activity Index; HOMA-IR, Homeostasis Model Assessment of Insulin Resistance; LN, Lupus Nephritis.