Lupus glomerulonephritis: a clinicopathological correlation of 93 patients of systemic lupus erythematosus for a follow-up period of three years.

A prospective study of 93 patients (female 86, male 7) of systemic lupus erythematosus (SLE) attending NRS Medical College and Hospital was done with special reference to their renal affection. Clinical features were noted and various laboratory parameters including auto-antibodies (ANF, anti ds DNA) were performed. Histopathological study of renal biopsy was carried out both at the time of presentation and subsequently 1 and 3 years later and lupus glomerulonephritis (LN) was categorised according to World Health Organisation (WHO) classification. Among the cases, 43 (46.23%) had some form of renal involvement at presentation. Additional 9 patients (9.68%) developed renal affection during 1 year of follow-up and after 3 years another 11 patients (11.83%) developed renal affection (total 63 cases, 67.74%). Histologically commonest pattern in renal biopsy was WHO class IV (21 cases, out of 63; 33.33%) followed by class III (20 cases; 31.75%). Rebiopsy was done in 33 cases of LN and 19 cases (30.16%) showed transformation from one biopsy class to another during the study period.Thus renal involvement seen in cases of SLE had a whole spectrum of histological pattern.The outcome of renal involvement is unpredictable so also is their tendency to transform from one biopsy class to another, usually from indolent class to the more virulent ones. There is dissociation between clinical finding and histologic severity. Hence renal biopsy should be done in all cases of SLE both initially and during follow-up, regardless of their individual clinical presentation.