Sobia Khalid, Zakia Wahid, Jahangir Mujahid, Shehla Mujahid, Imrana Tanvir, Nadia Naseem, Sabiha Riaz, Nagi A H.
Lupus Nephritis; Categorization of Proteinuria and Hematuria in patients with lupus Nephritis at a Tertiary Care Center in Lahore.
Professional Med J Jan ;25(7):1083-8.

Categorization of proteinuria and hematuria in patients with lupus nephritis at a tertiary care center Lahore. Objectives: Distribution of proteinuria and hematuria has a pivotal role in renal complications of systemic lupus erythematosus (SLE). Proteinuria and hematuria has been included as an independent descriptor in the SLE disease activity index (SLEDAI). Hence this study aims to categorize the proteinuria and hematuria in local population. Data Source: Fatima Memorial Hospital. Design of Study: Descriptive study. Setting: This study was conducted in the Department of Morbid Anatomy and Histopathology, at University of Health Sciences, Lahore. Samples were collected from the department of pathology at Fatima Memorial Hospital Lahore. Period: In 2015 from January till December. Methods: Urine was collected from 38 cases both male and female patients immediately prior to biopsy for evaluation of lupus nephritis. Relevant laboratory investigations, serum Antinuclear antibody (ANA) and Anti-double stranded DNA (Anti dsDNA) levels and renal function tests were recorded. The proteinuria and hematuria were detected and categorized by dipstick methods. Proteinuria was categorized on the following scale: 1+ = 200 - 500 mg/24 hours, 2+ = 500 - 1500 mg/24 hours, 3+ = 2500-3500 mg/24 hours and 4+ = >3500 mg/24 hours. Microscopic hematuria is categorized via RBC/HPF: 0?2 (negative), 3?10 (1+), 11?50 (2+), 51?100 (3+), and 100+ (4+). Microscopic hematuria was categorized as RBC/HPF: 0?2 (negative), 3?10 (1+), 11?50 (2+), 51?100 (3+), and 100+ (4+). Results: Among 38 patients the male to female ratio was 1:5. Mean age of the patients was 26.55 ± 8.13 years with age range of 14-49 years. A total of 37 (97.3 %) cases had proteinuria. The intensity of proteinuria was graded as 1+ in 4 (10.53%), 2+ in 14 (36.84%) and 3+ in 19 (50%) patients. Haematuria was present in 31 (81.58%) cases. Among these patients, the intensity was graded as 1+ in 11 (28.95%), 2+ in 9 (23.68 %) and 3+ in 11 (28.95%) cases. Serum ANA and anti dsDNA were positive in all cases regardless of disease progression. None of the variable showed any significant association when compared statistically. Conclusions: The grade of proteinuria increases rapidly with progression of the lupus nephritis in SLE which may be partly due to delayed diagnosis and brisk activity of the renal flares and partly as complication in SLE treatment in our population. Hematuria in the presence of proteinuria alone can suggest glomerular disease progression without the need for extensive urological investigations.

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