الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease in which diverse immunological events can lead to a similar clinical picture, characterized by a wide range of clinical manifestations and target organs.
Lupus nephritis is a serious complication of systemic lupus erythematosus (SLE; lupus) and is a major predictor of poor outcome
Renal biopsy has been the gold standard for assessment of kidney damage and disease activity, but its invasive feature has restricted its use.
Current laboratory markers for LN are unsatisfactory. They lack sensitivity and specificity for differentiating renal activity and damage in LN.
Significant kidney damage can occur before renal function is impaired.
Thus, novel biomarkers that are able to discriminate lupus renal activity and its severity, predict renal flares, and monitor treatment response and disease progress are clearly necessary.
A biomarker refers to a biologic, biochemical, or molecular event that can be assayed qualitatively and quantitatively by laboratory techniques.
Urinary biomarkers are easily obtained and probably are best at reflecting the current renal status.
TWEAK is a multifunctional cytokine that belongs to the TNF-ligand superfamily.
The major role of TWEAK in LN is centered on its pro-inflammatory and chemokine inducing effects
Our study included 44 patients with SLE and 11 age/ sex-matched healthy control subjects.
Subjects included in this study were subjected to :
- Full history taking and clinical examination.
- Routine laboratory investigations
- Measurement of uTWEAK level.
- Renal biopsy only for patients with lupus nephritis.
- Disease activity was assessed by SLE Disease Activity Index (SLEDAI) and renal disease activity by rSLEDAI.
The results obtained were statistically analyzed and summarized as follows:
1. Urinary TWEAK levels were significantly different in SLE patients with active LN compared to those without LN , with inactive LN and normal healthy subjects (p=0.001).
2. There was no significant correlation between uTWEAK levels and the demographic data of the patients e.g. age(r=0.01,p=0.990) and disease duration(r=0.29,p=0.195).
3. A statistically significant correlation was found between uTWEAK levels and tSLEDAI (r=0.61,p=0.003), rSLEDAI(r=0.75,p= 0.001) and non significant correlation between uTWEAK and extra renal SLEDAI(r=0.24,p=0.298)scoring systems.
4. A statistically non significant correlation was found between uTWEAK levels and all of the following: ESR (r=0.29& p=0.223),hemoglobin (r=-0.33&p=0.143), WBC count(r=0.02,p=0.947), lymphocytes(r=0.06,p=0.787) and platelets level(r=0.15,p=0.514).
5. There was significant positive correlation between uTWEAK levels and MCV(r=0.46,p=0.042).
6. There was no significant correlation between uTWEAK and serum creatinine.(r=0.07,p=0.777),blood urea(r=0.19,p=0.565) and serum albumin(r=0.12,p=0.723).
7. A statistically significant positive correlation was found between uTWEAK levels and hematuria (z=3.39 & p<0.001), pyuria (z=2.27 & p=0.023) & non significant correlation was found between uTWEAK levels and urinary casts (z=1.57 & p=0.117) and 24 urinary proteins (r=0.21 & P=0.365).
8. There was no significant correlation found between uTWEAK levels and systolic blood pressure (r=0.25 & p=0.273) and diastolic blood pressure (r=0.40& p=0.072).
9. There was no significant correlation between uTWEAK levels and C3(r=0.21,p=0.383) and C4 (r=0.01, p=0.970),.
10. A statistically non significant positive between uTWEAK levels and the presence or absence of anti-dsDNA(z=0.05,p=0.959), ANA(z=0.09,p=0.931) and CRP(z=0.31,p=0.756)
11. There were no significant differences between uTWEAK levels of patients with different classes of LN (z=1.70,p=0.094).
12. There was no significant correlation between uTWEAK levels and the presence of any of the following clinical manifestations (fever, loss of weight, fatigue, malar rash,alopecia , oral ulcers, discoid rash, photosensitivity, cutaneous vasculitis , Raynud’s phenomenon , muscle weakness, seizures, mood disturbances, arthralgia, arthritis,dyspnea ,tachycardia ,valvular affection , pericardial affection ,pulmonary hypertension, pleural affection, interstitial pulmonary fibrosis ,chest infection ,BOOP ,bronchitis , Abdominal pain, Hepatomegally, splenomegally, gastritis&duodenitis ,gastroenteritis, retinopathy, Roth’s spot and eye puffiness).
13. There was significant correlation between uTWEAK levels and Lower limb edema(z=3.21,p<0.001) , Tachycardia(z=3.38,p<0.001) , Valvular affection(z=1.98,p=0.047).
14. uTWEAK showed sensitivity of 100% and specificity of 66.67% for the presence of LN versus non LN
15. uTWEAK showed sensitivity of 100% and specificity of 80% for the presence of active LN versus inactive LN
IN CONCLUSION :
1- Urinary TWEAK may play a central role in the pathogenesis of LN.
2- Urinary TWEAK is able to discriminate lupus renal activity.
3- Urinary TWEAK is a very sensitive biomarker for early detection of active lupus nephritis
4- Urinary TWEAK is a highly specific biomarker for diagnosis of active lupus nephritis.
5- Urinary TWEAK level does not vary with different classes of LN.