ASSOCIATION OF DIFFERENT CLASSES OF PEDIATRIC LUPUS NEPHRITIS WITH ACTIVITY AND CHRONICITY INDICES IN BANGLADESHI POPULATION

Nafisa Sermin, Farjana Pervin Nupur,* Nafisa Abedin, Tanushree Paul, Afsana Papry, Fahmida Hasan Chowdhury, Rezwana Karim, Mumtahena Mahmuda, Nasrin Parvin Labani

ABSTRACT

Introduction: Lupus nephritis is one of the most common manifestations of SLE. Pediatric population, especially the adolescent age group have a higher chance of developing lupus nephritis. Aim of this study was to evaluate association of different histological classes of pediatric lupus nephritis with activity and chronicity indices in Bangladeshi population. Materials and Methods: This was a cross-sectional observational study conducted at the Department of Pathology, BSMMU. The study included the clinically diagnosed cases of pediatric lupus nephritis, from March 2021 to January 2023. Patients were enrolled by consecutive sampling after fulfilling the inclusion and exclusion criteria. Light microscopy findings of the formalin fixed paraffin-embedded renal biopsy specimens were evaluated and recorded according to the proposed ISN/RPS classification system of LN, 2018. Ethical measures were maintained throughout the study. The statistical analysis was carried out using the Statistical Package for Social Sciences version 22 for Windows (SPSS Inc., Chicago, Illinois, USA). Before starting this study, the research protocol was being approved by the IRB (Institutional Review Board) of BSMMU, Dhaka. Results:  The mean age was 13.96 ± 3.09 years ranged from 6 to 18 years. 83.75% of patients were female and 16.25% were male. Class II LN was the most common histological class (32.5%), followed by class IV (27.5%). The active lesions are more frequently seen (60%) than the chronic lesions (12.5%). Among the histological features of activity index, the neutrophils/karyorrhexis was the most frequent that was present in 62 (77.5%) cases and it was most frequent in class IV LN (95.5%). Among the histological features of chronicity index, interstitial fibrosis was present in majority (30.0%) of cases, most frequently in class IV LN. Four of the activity indices and one of the chronicity indices were found significantly associated with histological classes of LN. Conclusion: Class II LN was found to be the most common class of lupus nephritis according to the modified ISN/RPS 2018 classification system. Four of the activity indices and one of the chronicity indices were found statistically significant.

Keywords:

Lupus nephritis, Nephrotic syndrome, Activity index, Chronicity index.

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