الفهرس 
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Abstract
Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune disorder that may affect multiple organ systems. Many of its clinical manifestations are secondary to immune complex deposition in capillaries of visceral structures or to autoantibody mediated destruction of host cells. The clinical course is characterized by remissions and relapses. The severity may vary from a mild episodic disorder to a rapidly fulminating life threatening illness. SLE is up to 10 times more common in women than men, and typically has a predilection for women in their childbearing years.
The kidney is the most commonly involved visceral organ in SLE. Although only approximately 50% of patients develop clinically evident renal disease, biopsy studies demonstrate some degree of renal involvement in almost all patients. LN varies from isolated abnormalities of urinary sediment to full-blown nephritic or nephrotic syndrome or chronic renal failure.
Substantial animal and human evidence suggests that chemokines, in particular monocyte chemoattractant protein-1 (MCP-1), contributes to kidney injury in the glomerulonephritis (GN) of SLE.
The aim of these work is to study the role of urinary monocyte chemoattractant protein-1 (MCP-1) as a marker of lupus nephritis activity and to test its validity as a follow up marker.
This study included 60 patients with SLE fulfilling the American College of Rheumatology preliminary criteria for diagnosis of SLE. 10 of age and sex matched healthy subjects were taken as control group [group I]. 20 patients without any signs of activity as [group II]. 20 patients with lupus activity other than nephritis as [group III]. 20 patients with active lupus nephritis during activity and during follow up (4 weeks later) as [group IV].
All patients were subjected to: detailed history taking with special stress on symptoms related to renal affection and a complete clinical examination. Also the SLE disease activity index (SLEDAI) was applied for every lupus patient of the studied group and the scores were estimated.
Laboratory investigations done for the studied group of patients included:Complete blood picture, erythrocyte sedimentation rate (ESR), liver enzymes (ALT, AST), renal function tests (blood urea, serum creatinine, and 24 hour urine protein), complete urine analysis, antinuclear antibodies (ANA) titre, antidouble stranded DNA antibodies (anti ds-DNA) titre, and urinary MCP-1 levels. Renal biopsy performed to all SLE patients with clinical and laboratory evidence of renal involvement. Determination of the activity and chronicity indices performed according to the scheme of the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification of lupus nephritis.
The results of our study showed that:
• The mean value of urinary MCP-1 in SLE patients was significantly higher than the mean value in normal healthy control, p (<0.001).
• The mean value of urinary MCP-1 in SLE patients with nephritis was significantly higher than the mean value in SLE patients without lupus nephritis, p (<0.001).
• The mean value of urinary MCP-1 in group IV (active nephritis) during activity was statistically significantly higher than that during follow up with P value of (0.009)
• The mean value of urinary MCP-1 in group III (active not nephritis) was statistically significantly higher than that of group I and II with P value of (0.001).
• There was statistical significant correlation between urinary MCP-1 and serum creatinine in active nephritis group (p= 0.001). Also, urinary MCP-1 showed a positive significant correlation with proteinuria (p< 0.001), serum anti ds-DNA (p= 0.038), SLEDAI score (global) (p< 0.001), and renal SLEDAI score (p< 0.001). There was a negative significant correlation between urinary level of MCP-1 and serum level of C3 in patients with active lupus nephritis during activity (p= 0.024).
• There was no association between urinary MCP-1 and activity and chronicity indices (p= 0.872 and 0.674).
• The urinary MCP-1 level was found to be higher in patients with diffuse proliferative GN (class IV) than in focal proliferative GN (class III). The non-proliferative form of lupus nephritis (class II) had the lowest level of UMCP-1, with a statistically significant difference (p = 0.035).
• The mean value of urinary MCP-1 decreased significantly in patients who achieved partial remission unlike those who did not achieve remission with P value of (0.021).