A Clinicopathological Study of Refractory Lupus Nephritis in Tertiary Care Hospital in North East India

Background: Lupus nephritis is a dreaded and common manifestation observed in 50% of the individuals with systemic lupus erythematosus, an autoimmune clinical condition. Refractory lupus nephritis as per definition is failureto respond to any combination of immunosupressants and corticosteroids for atleast six months. Approximately 10% of lupus nephritis patients will ultimately develop ESRD. Objectives: The available literature and data on refractory nature of the lupus nephritis is very limited. Hence, we have aimed to investigate the clinical spectrum and rate of response to the treatment in our lupus nephritis patients in a Tertiary Care Hostipal in North East India. Methodology: This was a single center prospective observational study done over a period of 1 year. Patients were enrolled after fulfilling the SLICC - ACR criteria. Clinical manifestations were recorded and blood samples were analysed for the presence of anemia, thrombocytopenia, leucopenia, ANA, anti dsDNA, C3 and C4. The levels of C - reactive protein, creatinine, albumin, cholesterol and urine protein were also analysed. Renal biopsy was done in all the patients and categorised as per the ISN/RPS classification. The obtained values were subjected to statistical analysis and pless than0.05 and pless than0.01 were considered statistically significant. Results: Eighty one lupus nephritis patients were studied (females: 75, male: 6). The presence of elevated levels of dsDNA, C - reactive protein (at the beginning), creatinine, cholesterol, urine protein and reduced C3 and C4 altered the response rate significantly (p less than0.01). The increased activity index value was also found to be significantly associated with non response in lupus patients. The increased chronicity index value and elevated C - reactive protein levels were also found to be positively associated with no response rate (pless than0.05). Conclusion: Refractory lupus nephritis is significantly associated with higher ds DNA, C - reactive protein, creatinine, cholesterol, urine protein levels and reduced C3 and C4 level.