title: Renal involvement in systemic lupus erythematosus in Pakistan.
abstract: OBJECTIVE
  To find the prevalence of lupus nephritis, delineate its clinical, immunological and therapeutic characteristics and compare them with the data worldwide.
  
  
  METHODS
  Between 1985 and 2001, 198 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association (ARA) admitted to the hospital were studied by means of a retrospective review of their records.
  
  
  RESULTS
  Renal involvement was found in 89 (45%) patients. Biopsy showed lupus nephritis in 42 patients; there were 9 male and 33 females. Mean age at initial presentation was 27 years and mean duration of follow-up was 2 .3 years. The histological types (WHO Classification) were mainly class. 4 (n = 27), class 3 (n = 7) and class 5 (n = 6). Immunoflourescence showed a predominantly granular pattern of IgG, IgA and C3. Renal manifestations included renal failure (50%), microscopic hematuria (67%), active urine sediment (22%), and proteinuria (74%). Proteinuria was nephrotic range in 45% patients. Treatment was with combinations of prednisolone and cyclophosphamide (n = 13), prednisolone and azathioprine (n = 27). 19 patients received high dose methyl prednisolone (1 gm/day for 3 days). There was no difference in mortality rate between prednisolone and cyclophosphamide and prednisolone and azathioprine treatment groups. The overall mortality rate was 17% (n = 7). Mortality was higher in WHO class 4 and 5 as compared to class 2 and 3 (p < 0.001).
  
  
  CONCLUSIONS
  The prevalence of lupus nephritis in our population is an intermediate between Caucasians and other Asians. Certain clinical characteristics in our patients with lupus nephritis are different as compared to various other studies. Because of limited resources for treatment in developing countries, we believe that patients with lupus nephritis should be treated with improved ancillary medical therapies and more effective immunosuppressive regimens.
authors.affiliation: Department of Medicine, The Aga Khan University Hospital, Karachi.
authors.forename: Malik Anas
authors.initials: MA
authors.lastname: Rabbani
authors.forename: Muhammad Hammad
authors.initials: MH
authors.lastname: Tahir
authors.forename: Bilal Karim
authors.initials: BK
authors.lastname: Siddiqui
authors.forename: Bushra
authors.initials: B
authors.lastname: Ahmad
authors.forename: A
authors.initials: A
authors.lastname: Shamim
authors.forename: Syed Mansoor Ahmed
authors.initials: SM
authors.lastname: Shah
authors.forename: Aasim
authors.initials: A
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008181:Lupus Nephritis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011239:Prednisolone / Q000627:therapeutic use; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D003520:Cyclophosphamide; D011239:Prednisolone; D001379:Azathioprine