Title: Lupus nephritis

Biography:

Syed Musavi trained in internal medicine at the premier postgraduate medicine institute of Pakistan, Jinnah Post Graduate Medical Center . Following their structured training programme he obtained a fellowship degree in Internal medicine from College of Physicians and Surgeons Pakistan. He also trained in Sindh Institute of Urology And Transplantation, a very prestigious hospital and one of the largest nephrology, dialysis and transplant centres in Asia, where nearly 4000 transplants have taken place and nearly 800 patients are dialysed daily. He worked there as a senior lecturer. Later he moved to UAE to work in the Nephrology unit in Dubai hospital and gained further exposure to nephrology and dialysis practices in the Middle East and during this period he completed MRCP UK in 2011. To further enhance his skills in renal medicine Syed got an opportunity to work in Ireland and has enjoyed working in the nephrology and dialysis units of various hospitals there as well as practicing a good mixture of general medicine. He has attended various international conferences in nephrology and scientific meetings to improve his knowledge and skills in order to improve his patient care. During his career he was also involved in the teaching of undergraduate and post graduate students. Currently he has been working in Ennis General Hospital,Ireland as Medical Consultant.

Abstract

Systemic Lupus Erythematosus (SLE) is an autoimmune chronic inflammatory disease which affects multiple organs of the body. Lupus nephritis is one of the serious complications of SLE and it is the predictor of poor outcome. The incidence of Lupus Nephritis (LN) in patients with SLE is quite common. In SLE, females outnumber males. While in Lupus nephritis both genders are equally affected. Circulating Immune complexes and in situ formation in Glomeruli will lead to pathogenesis in LN. Clinical presentations in LN range from asymptomatic haematoproteinuria on urine analysis with normal renal function to nephritic and/or nephrotic syndrome and Rapidly progressive glomerulonephritis with renal failure and hypertension. Screening panels including noninvasive work like urine analysis, biochemical and autoimmune profile necessitating invasive approach by doing kidney biopsy. Autoantibodies production are hallmarks of SLE.The firm diagnosis of LN cannot be made in the absence of Antinuclear antibodies.Antibodies against dsDNA is more specific but are less sensitive. SM antibodies are strongly associated with Lupus. C1q is more related to Lupus activity. Classification of Lupus Nephritis is classified into VI classes based on kidney biopsy revised by International Society of Nephrology. Not all Kidney disease with LN need to be treated aggressively with immunosuppression. Class III and class IV need to be treated aggressively. While, class II, chronic changes with little active inflammation do not. Moreover, not all kidney diseases in lupus is lupus Nephritis few cases with lupus nephritis have other glomerular disease most commonly Minimal change disease and Focal segmental glomerulosclerosis Therefore, kidney biopsy is vital not only for diagnosis, it also help to determine the treatment modality along with the prognosis. In general, patients with class I and class II LN need no therapy other than extra renal therapy. Treatment of severe active Lupus Nephritis is separated into an induction phase to induce remission and maintenance phase. Based on clinical trials the therapeutic options available are steroid, Cyclophosphamide and Mycophenolate mofetil. The decision of therapy is based on patient choice, available facilities, consideration of side effect profile and monitoring facilities. Lupus nephritis needs long term surveillance with consideration of socioeconomic and pharmacogenetics aspects of disease and treatment related complication.