الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory multisystem disease characterized by a very large spectrum of clinical manifestations accompanied by prototypic abnormalities of the immune system with unpredictable flares and remissions. 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 severity may vary from a mild episodic disorder to a rapidly fulminating life threatening illness. The exact patho-etiology of SLE remains elusive. An extremely complicated and multifactorial interaction among various genetic and environmental factors is probably involved.
Lupus nephritis (LN) is one of the most serious complications of SLE since it is the major predictor of poor prognosis. 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. Glomerular disease usually develops within the first few years after onset of SLE and is usually asymptomatic.
The aim of this study was to evaluate the predictive value of renal resistance index (RRI), measured by Doppler Sonography in comparison with disease activity score, serologic and biology parameters in lupus nephritis.
This study included 43patients with SLE fulfilling the Systematic Lupus International Collaborating Clinics (SLICC) Classification 2012 Criteria; group I included 33 patients with lupus nephritis, group II included 10 SLE patients without lupus nephritis and group III included 10 age and sex matched healthy subjects as control group.
All patients were subjected to detailed history taking and clinical examination with special stress on demographic and clinical manifestations for the presence of: skin, eye, cardiovascular, respiratory, renal, neuropsychiatric and hematological manifestations were performed.
Laboratory investigations done for the studied groups which included: Complete blood picture, fasting blood sugar, blood urea, serum creatinine, serum albumin, eGFR, complete urine analysis, urinary albumin creatinine ratio, erythrocyte sedimentation rate(ESR), CRP, antinuclear antibodies (ANA), antids DNA antibodies titer, C3 and C4. Renal biopsy performed to all LN patients. 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 SLE disease activity index (SLEDAI) and renal scores were applied for every lupus patient of the studied group and the scores were estimated. Ultrasound evaluation of kidneys and renal Doppler with measurement of renal resistive index (RRI).
The results of the study showed that:
• The mean value of HGB in LN cases was significantly lower than that of SLE patients and the healthy group. No significant difference was observed between the SLE and the healthy group.
• The mean value of blood urea and serum creatinine were statistically significant higher in group I than that of the other two groups.
• The mean value of eGFR and serum albumin were statistically significantly lower in group I than other 2 groups.
• The mean value of urinary AC ratio was statistically significantly higher in group I than the other two groups.
• The mean value of ESR was statistically significantly lower in group III than that of group I and group II with no significant difference between LN and SLE patients.
• The mean value of CRP in group III was statistically significant lower than that of group II and with no significant difference between group I and group II or III.
• There was a significant difference of the mean values of Anti ds-DNA between group I and group III or group II and group III. No significant differences were observed between group I and group II.
• The mean value of C3 in the healthy is significantly higher than that of the LN group only. There was also a significant difference between LN and SLE patients.
• Renal biopsy of LN patients showed that 66.6% of patients had class IV LN and 15.15% of patients had class V LN.
• The mean value of activity index was 7.51± 4.06 and the mean value of chronicity index was 2.54± 2.07.
• The mean of the SLEDAI score in LN group was statistically significant higher than that of SLE group. The mean value of Renal SLEDAI score was10.62 ± 3.14 and the mean value of SLICCRAS score was 9.46 ± 3.91.
• The mean value of Doppler-Based RRI in the healthy group is significantly lower than the LN and SLE patients with a statistically significant difference. LN and SLE patients showed also a significant difference.
• Age, blood urea, serum creatinine, HB, urinary AC ratio, mean blood pressure, FBS, ESR2 , serum complement C3 and chronicity index were statistically significantly correlated with the RRI. Multiple regression analysis shows that no variable was a significant predictor for Doppler-Based RRI.
• The mean age of those who had resistive index of 0.7 and above was higher than those below 0.7. This difference was significant. The same pattern was observed for blood urea, creatinine and renal biopsy chronicity index.
• The Area under the ROC curve (AUC) of Doppler-Based Renal Resistive index as a marker of renal biopsy chronicity index was 0.769 (95% confidence interval). Therefore there is evidence that RRI has an ability to distinguish between the two positive and negative groups.