Nephritis as an initial diagnosis of lupus in Nigerian patients

Abstract

Background: Systemic Lupus Erythematosus (SLE) is a multi-systemic autoimmune disease. Renal involvement is a common complication, causing considerable mortality and morbidities. SLE is rarely reported among black Africans, though recent reports from Nigeria indicate otherwise. Nephritis, though a common complication of SLE has rarely been reported as the initial diagnosis of lupus among black Africans. Aims: The aim of our study is to highlight the clinical, laboratory and histological features in Nigerian patients presenting with features of nephritis and subsequent diagnosis of SLE. Methods: This is a three-year prospective study of patients with renal diseases, who were admitted to the rheumatology and nephrology units of the Lagos State University Teaching Hospital (LASUTH) Ikeja. Serology, biochemical, hematologic tests, kidney biopsy was done. Results: Twelve patients were studied (F11; Ml); mean age 30.4 years (SD± 9.8); mean illness 8weeks (SD±6.6). Six patients had a nephritic condition. Nine of the patients had baseline hypertension while 3 had a rapidly progressive nephritis. Two patients had baseline End Stage Renal Disease (ESRD). All had dipstick proteinuria 2+ / 3+ , mean protein creatinine ratio 2.2 (SD ±0.6) ,mean 24hr protein 2.8gm(SD±2.7);more than 10 red blood cells/hpf hematuria(n-6),hyaline casts(n-5), granular casts(n-2),mean GFR 31.4ml/ min(SD±21.3),mean serum creatinine 6.9mg/dl(SD± 5.3); mean urea 138.8mg/dl(SD±56.2). For the serology, Anti-Nuclear Antibody (ANA) was positive in all the 12 subjects; positive anti dsDNA -10 patients; ENA - 10. Renal biopsy showed mostly WHO/ISSN classes III, IV and V. Treatment was with Euro Lupus regimen and rituximab/ cyclophosphamide. Four patients had dialysis. In terms of the outcome, there were 3 deaths while 9 patients were discharged. Conclusion: A high index of suspicion is needed to diagnose Lupus Nephritis in black African s especially when their presentations do not fulfil the America College of Rheumatology (ACR) diagnostic criteria for SLE.