Systemic multiple organ systems.2 Kidney is considered to be

Systemic lupus
erythematosus (SLE) is an autoimmune, multiorgan disease that usually affects
young women.1 It can affect multiple organ systems.2
Kidney is considered to be the signature organ affected by SLE.2
Every tissue component of the kidney can be affected, but glomeruli are the
target structure in most patients.2

        Abnormal urine analysis with or without
an elevated plasma creatinine concentration is present in a large proportion of
patients at the time of diagnosis and eventually develop in 65% of patients.3
Most frequently observed abnormality is proteinuria.3 All studies
identified lupus nephritis as an important predictor of poor outcome.4
Renal disease is present in one half to two thirds of patients and is diagnosed
based on the presence of proteinuria (>500mg/24 hours).3

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        There are a number of types of renal
diseases in SLE, usually differentiated by biopsy.5 If not treated
appropriately 10-15% of patients with lupus nephritis progress to end stage
renal disease, requiring dialysis or renal transplantation.5

        Major criteria of classification include
the focal and diffuse involvement of the glomerulus, the site of
hypercellularity, the site of immune complex deposition and the presence of
active or sclerotic lesions.6 The classification of lupus nephritis
is critical to the issue of patient care and for the comparison of  outcome results.5 In several
studies of lupus nephritis, type IV nephritis is the most common approximately
40% whereas type III and type V follow with an approximate frequency of 25% and
15%.7,8

        While another recent study published in
Nepal determined the clinical profile and patterns of lupus nephritis patients,
which shows grade 1 changes in 5 (13.5%) patients, grade 2 changes in 13
(35.1%) patients, grade 3 changes in 9 (24.3%) patients, grade 4 changes in 7
(18.9%) patients and grade 5 changes in 2 (5.4%) patients on histopathological
findings which shows contradiction to the findings of the above studies.9

The rationale of the study
is that in Pakistan only two studies 7,8 were published with small
sample size in 2004 and 2006 respectively, these studies are more than 5 years
old and also in contradiction with the findings of the above study by showing
class III as the commonest lesion which needs to re-search the frequency of
classes of lupus nephritis on histopathological findings in current era.Systemic lupus
erythematosus (SLE) is a multisystem autoimmune disease primarily affecting
women of reproductive age.10,11 There is a particular
pre-disposition to develop SLE.10,11 Indeed, during the course of
their disease, the kidney is a major target organ in up to 60% of patients with
SLE, with 25–50% presenting with kidney involvement already at the time of
lupus diagnosis.11 The presentation of lupus nephritis is highly
variable, ranging from mild asymptomatic proteinuria to rapidly progressive
glomerulonephritis with haematuria and red cell casts.11 Features
invariably include some degree of glomerular proteinuria—nephrotic in 45–65% of
the cases.11

We planned this
study considering the fact that in Pakistan only two studies8,9  were published with small sample size in 2004
and 2006 respectively, these studies are more than 5 years older and also in
contradiction with the findings of Dhakal SS and co-workers 9 by
showing class III as the commonest lesion which needs to re-search the
frequency of classes of lupus nephritis on histopathological findings in
current era.

        The results of our revealed that
majority of the patients were between 31-50 years i.e. 68.67%(n=57), mean +
SD was calculated as 43.76±4.74 years, which shows that the morbidity is more
prone between 31-50 years of age, and it was more common in female patients
59.03%(n=49). Our findings are consistent with the results of the study
conducted by Muhammad N 8 and colleagues who recorded 84% of the
patients between 20-40 years and 92% of the cases were females.8
Patterns of lupus nephritis according to WHO classification were recorded which
shows 9.63%(n=8) had Class I, 21.68% (n=18) Class II, 26.50% (n=22) Class III,
32.53% (n=27) Class IV, 6.02% (n=5) Class V and 3.61% (n=3) had Class VI.

        The findings of the study are in
agreement with two studies 8,9 
conducted in Pakistan by showing class III as the commonest lesion while
a slight difference with Dhakal SS 9 as they determined the clinical
profile and patterns of lupus nephritis patients, which shows grade 1 changes
in 5 (13.5%) patients, grade 2 changes in 13 (35.1%) patients, grade 3 changes
in 9 (24.3%) patients, grade 4 changes in 7 (18.9%) patients and grade 5
changes in 2 (5.4%) patients on histopathological findings, these findings are
not significantly different between the two classes i.e. Class II and III.

        Ethnic variation in the prevalence,
incidence and severity of lupus nephritis is well documented in the literature 12
the age and sex ratio in our study corresponds well with the data published so
far, which shows disease proclivity for young females in their reproductive age
period, which needs special attention for timely management of the morbidity.