Browsing by Subject "Lupus nephritis"
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- ItemOpen AccessCorrelation of urinary mcp-1 and tweak with renal histology and early response to therapy in newly biopsied patients with lupus nephritis in cape town, South Africa(2019) Moloi, Mothusi Walter; Okpechi, Ikechi; Rusch, Jody AlanBackground: There is need for judicious use of immunosuppression in patients with active lupus nephritis (LN), however this is guided by renal biopsy which is invasive and not freely available in most centres. Novel urinary biomarkers such as monocyte chemoattractant protein-1 (MCP-1) and tumour necrosis factor-like weak inducer of apoptosis (TWEAK) are secreted in the kidney and may be useful for predicting histological class, monitoring flares and assessing response to therapy. We assessed the utility of urinary MCP-1 (uMCP-1) and TWEAK (uTWEAK) in predicting renal histological findings, disease flares and treatment response 6 months following initiation of treatment for LN in newly biopsied patients. Methods: We recruited consenting patients with active LN confirmed on kidney biopsy. Relevant baseline demographic, biochemical and histological information was collected from the patients. ELISA methods were used to assess uMCP-1 and uTWEAK at baseline and at 6 months after completion of induction therapy. Results: There were 14 females and 6 male patients with a mean age of 29.8 ± 10.7 years, 60% were of mixed ancestry, 70% had proliferative LN. There was no association between uMCP-1 and uTWEAK and histological features (LN class, activity index, chronicity index and interstitial fibrosis). At 6 months, 6 patients were lost to follow-up and of the remaining 14, 12 (85%) attained remission (partial remission (n = 7) or complete remission (n = 5)). Both biomarkers were elevated in patients with active disease and significantly declined amongst those attaining remission, p = 0.018 and p = 0.015 respectively. However, for those not attaining remission, no association was found for both biomarkers (p >0.05). Conclusion: Our study did not show correlation between uMCP-1 and uTWEAK with histological features of LN. However, both biomarkers were elevated in patients with active disease and correlated with the remission status at the end of induction phase of treatment.
- ItemOpen AccessDiagnostic performance of glomerular PLA2R and THSD7A antibodies in biopsy confirmed primary membranous nephropathy in South Africans(2021-01-07) Lwezaula, Bingileki F; Ameh, Oluwatoyin I; Ekrikpo, Udeme E; Botha, Francois C; Okpechi-Samuel, Ugochi S; Wearne, Nicola; Ronco, Pierre; Bello, Aminu K; Okpechi, Ikechi GBackground: Serum and tissue-based tests using phospholipase A2 receptor 1 (PLA2R) and thrombospondin type-1 domain containing 7A (THSD7A) are established immune biomarkers for the diagnosis of primary membranous nephropathy (PMN). This study assessed the diagnostic performance of these biomarkers in the diagnosis of PMN in South Africans. Methods This was a cross-sectional analysis from a single centre in Cape Town, South Africa. Relevant biodata was collected from all patients. Histology, including slides for PLA2R and THSD7A were processed and assessed by typical microscopic and immunohistochemical features. Biopsy tissues of patients with membranous lupus nephritis (LN-V) and diabetic nephropathy (DN) were used as controls. The diagnostic accuracy for diagnosis of PMN using positive PLA2R and THSD7A were evaluated. Results Of the 88 patients included, 41 had PMN with a mean age of 44.5 ± 17.5 years and 61.0% were female. Histologically, PLA2R and THSD7A were only positive in the PMN group (51.2% and 4.9%, respectively) but negative in both control groups. The sensitivity of PLA2R and THSD7A for identifying PMN was 51.2% and 4.9%, respectively. The sensitivity of both tests together was 53.7% while the specificity and positive predictive values (PPV) for any of the tests (alone or in combination) was 100%. There was no difference in the sensitivity and specificity when using PLA2R alone compared to combining the two tests (p=0.32). Conclusion Glomerular staining of PLA2R and THSD7A could have potential diagnostic values in South Africans. This has implications on how immunotherapies can be initiated and used in these settings.
- ItemOpen AccessOutcomes of renal transplantation in patients with lupus nephritis: a single centre study in Cape Town(2017) Almradi, Ahmed Khalifa Mohamed; Okpechi, Ikechi GBackground: Kidney disease (lupus nephritis [LN]) constitutes a feature of systemic lupus erythematosus (SLE) in up to 50 - 70% of patients with the disease. Although most LN patients are suitable for renal transplantation when they develop end stage renal disease (ESRD), the risk of recurrence of LN post-transplantation can be as high as 30%. Since the outcomes of renal transplantation in ESRD-LN patients has not been adequately studied in South Africa, the present study aims to retrospectively explore the aforementioned objective in a single centre. Methodology: The study was designed as a retrospective descriptive study of patients with LN transplanted in the renal unit of Groote Schuur Hospital, Cape Town from 1st January 2004 to 31st December 2013. Results: There were 454 patients who were transplanted in the study period of which 15/454 (3.3%) had LN. The M:F ratio of LN patients was 1:14, mean age was 25±10 years, all were known with class- IV LN and 10/15 (66.7%) received graft from a cadaveric donor. Immunosuppression was initiated in 7/15 (46.7%) with combination of cyclosporine and azathioprine; in 2/15 (13.3%) with tacrolimus and azathioprine and in 6/15 (40.0%) with Tacrolimus and MMF. All patients received corticosteroids. Recurrence of LN was seen in one patient (6.7%) who developed class V LN. Graft rejection was diagnosed in 10/15 cases (66.7%) with types of rejection noted to be acute cellular rejection in 6/15 (40%), antibody mediated rejection 1/15 (6.7%) and chronic rejection in 3/15 (20%). ESRD occurred in 3 patients (20%) with causes from antibody mediated rejection (6.7%), chronic allograft nephropathy (6.7%) and renal artery thrombosis (6.7%). Mean time to ESRD was 16.0 months. Five deaths (33.3%) occurred from sepsis in 3/15 (20%), pulmonary embolism; 1/15 (6.7%) and progressive ESRD after non-acceptance to the chronic dialysis program; 1/15 (6.7%). Mean time to death was 44.1 months. Conclusion: This study shows that recurrence of LN in the graft kidney is uncommon in South Africa. However, effort to reduce high rates of rejection and improve graft and patient survival still needs to be studied.