الفهرس 
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Abstract
Autoantibody production leads to numerous organ damage in systemic lupus erythematosus (SLE), an idiopathic inflammatory illness. Lupus nephritis (LN) is a serious renal complication of systemic lupus erythematosus (SLE), affecting 30–50% of patients at diagnosis. It is indicated by persistent proteinuria (≥0.5 g/day) and/or the presence of cellular casts, such as red blood cells, hemoglobin, or granular casts. For proliferative and membranous lupus nephritis (LN), induction therapy involves high-dose methylprednisolone and immunosuppressive medications for six months. Achieving a full response may take several months after this induction phase. Renal involvement in systemic lupus erythematosus (SLE) typically occurs within the first five years. It remains unclear if the timing of lupus nephritis (LN) onset affects disease severity or long-term prognosis. Few studies compare early-onset LN (within 5 years of diagnosis) with late-onset LN (more than 5 years post-diagnosis). Aim of the work: The aim of the current work is study the relation between onset of lupus nephritis (LN) in systemic lupus erythematosus (SLE) patients and renal outcome as well as treatment response in early and late onset LN. Patient and methods : This study is a retrospective cohort study. Consisting of 300 lupus nephritis (biopsy – proven) patients who were categorized into two groups as in previous studies, early-onset LN( developed within 5 years of SLE diagnosis ) and late-onset LN( developed more than 5 years after SLE diagnosis ) . All patient’s data was collected at baseline (onset of LN), 6 months, 1 year, 2 years and 5 years after onset of LN to study the relation between onset of lupus and renal outcome. This study revealed the following results: Early LN group included 225 patients . Late LN group included 75 patients . Patients with early lupus nephritis had higher mean age of lupus diagnosis with statistically significant difference. However, no significant differences were found between both groups as regard age of LN diagnosis. Median value of 24- hour urinary protein was significantly higher in early LN than late LN . Cholesterol levels were significantly higher in early LN group than late LN group. All patients underwent renal biopsy either due to proteinuria only or proteinuria and rising of s. creatinine with statistically significant differences between early and late LN groups. Most of renal pathologies in early and late LN groups were class III or IV, while early LN group had lower mean values of chronicity index with statistically significant difference. As regard received treatment, higher percent of patients in early LN group received pulse steroid significantly . There were statistically significant differences between both groups as regard received induction therapy as higher percent of patients in late LN group did not receive induction therapy while higher percent of early LN patients received IV cyclophosphamide as induction therapy. There were no statistically significant differences between both groups as regard maintenance immunosuppressive therapy. Renal re- biopsy was performed for 50 patients (39 early lupus nephritis and 11 late lupus nephritis) with no statistically significant difference between early and late LN groups, the indications for 2nd biopsy were no- response or progression after 6 months of treatment. After one year of follow up, seven patients in early lupus nephritis group underwent 3rd biopsy, while no cases in late LN group underwent renal biopsy for the 3rd time. After 1 year of follow up, there were no statistically significant differences between both groups as regard different laboratory investigations including s. creatinine, 24- hour protein, albumin, cholesterol and CBC. Third induction was given to 6 patients in early LN group and two patients in late LN group with no statistically significant differences. After 2 and 5 years of follow up, there were no statistically significant differences between both groups as regard proteinuria, s. creatinine, albumin, cholesterol and hematological criteria. Additionally, incidence of acute kidney injury (AKI) at 6 months, 2 years and 5 years of follow up was comparable between both groups. However, incidence of AKI was significantly higher in early LN group than late LN group at baseline and at 12- month of follow up. Overall Number of patients experienced AKI was higer in early LN group than late LN group. Out of 300 SLE patients, 214 experienced at least one attack of acute kidney injury (AKI) during the 5-year follow-up period. Predictors for developing AKI included: Shorter duration between SLE and lupus nephritis (LN) diagnosis, Higher baseline serum creatinine, Higher 24-hour urinary protein, Lower hemoglobin levels, Proliferative lesions on kidney biopsy and Higher activity and chronicity indices on kidney biopsy . Out of the 214 patients who developed AKI, 88 showed full recovery. Predictors of full AKI recovery included: Early LN diagnosis, Higher BMI, Lower baseline serum creatinine and Lower chronicity index on kidney biopsy. After 5 years of follow-up, 126 patients had poor renal outcomes (CKD or hemodialysis), while 174 had good renal function. Predictors of good renal outcome included: Higher BMI, Lower baseline serum creatinine, Lower proteinuria, Higher hemoglobin, Non-proliferative kidney lesions and Lower activity and chronicity indices . 25 patients required maintenance hemodialysis at the end of follow-up. Predictors of requiring hemodialysis included: Higher baseline serum creatinine, Lower hemoglobin, Proliferative kidney lesions, Higher activity and/or chronicity indices. Conclusions : based on the results of our study, it could be included that: Most of patients with SLE had early LN with highest 24- hour urinary protein and cholesterol levels and they had higher percent received pulse steroid and IV cyclophosphamide as induction therapy. AKI more occurred in early LN patients with higher percent of patients fully recovered . High baseline s. creatinine was predictor for AKI while the duration between SLE and LN diagnosis, early LN, high BMI and low chronicity index were predictors for recovery of AKI. In another word, early LN, higher BMI, low baseline s. creatinine, non- proliferative and low chronicity index were predictors for good renal outcome. The predictors for hemodialysis was higher baseline s. creatinine.