A case of renal transplantation

A 12-year-old boy was admitted in paediatric nephrology unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) with massive proteinuria, hypertension, respiratory distress and anaemia and diagnosed as nephrotic syndrome. Percutaneous needle biopsy was consistent with diffuse endocapillary proliferative glomerulonephritis and initially managed conservatively with injection methyl prednisolone, cyclophosphamide, lisinopril etc. without any improvement. Living-related renal transplantation was done successfully from paternal uncle. Two episodes of acute rejection occurred, one immediately after transplantation and another after one month. These were managed with IV methyl prednisolone for 3 days. At present, he is on oral prednisolone, cyclosporine, azathioprine and antihypertensives with normal haemoglobin and stable serum creatinine level (pre-transplant level 12.5mg/dl to post-transplant level 1.5mg/dl). He has been maintaining his normal life including schooling for last few months. It is concluded that a patient with uncommon presentation of nephrotic syndrome should be confirmed by renal biopsy and renal transplantation may be considered if conservative measures fail.     

Homocysteinemia in hypertensive patients with renal target organ damage (mild renal dysfunction)

The prevalence of high plasmatic levels of homocysteine in hypertensive patients with mild renal dysfunction (MRD) defined by 2003 European Hypertension Society Guidelines (men plasmatic creatinine between 1.3 and 1.5; women plasmatic creatinine between 1.2 and 1.4 mg/dl) has not been previously reported. To evaluate this item 18 MRD patients were recruited (54% males, mean age 59.2 +/- 17.3 years, mean plasmatic creatinine 1.30 +/- 0.12 mg/dl). They were compared with a control group of hypertensives with normal renal function (n = 87, 42,9% males, mean age 53.6 +/- 12.3 years, mean plasmatic creatinine 0.83 +/- 0.21 mg/dl) and a group of 29 chronic renal failure patients (51.7% males, mean age 56.9 +/- 15.0 years, mean plasmatic creatinine 2.39 +/- 0.95 mg/dl). Age and sex differences are not significant, plasmatic creatinine levels are different among three groups (p <0.001, t student test). Basal homocysteine levels of CRF (19.3 +/- 7.1 micromol/l) were higher than those of control group (11,0 +/- 4,3 micromol/l) and MRD patients (14.8 +/- 5.5 micromol/l; p = 0.027 vs. CRF and p = 0.007 vs. control, Mann-Whitney test). Mean creatinine clearance was 30.3 +/- 11.5 ml/min for CRF group, significantly lower than MRD patients creatinine clearance (54.5 +/- 9.4 ml/min, p <0.001, t student test) and control ones (88,9 +/- 18,9 ml/min, p <0.001, t student test). Hypertensive patients with mild renal dysfunction showed higher and pathological levels of homocysteinemia as compared with controls, this finding might be related to the higher cardiovascular risk described in this group of patients.     

Study of serum electrolytes in pregnancy induced hypertension

Hypertension complicating pregnancy is an important cause of foetal and maternal mortality and morbidity. Serum sodium, potassium, calcium and magnesium were evaluated in cases with gestational hypertension and pre-eclampsia and compared with normotensive pregnant women of corresponding period of gestation. Taking urinary micro-albumin creatinine ratio as standard to predict pregnancy induced hypertension, the role of serum electrolytes to predict the same was studied. A total of 200 patients were evaluated. There were no change in serum sodium and potassium in gestational hypertensive cases as well as in pre-eclamptic cases when compared with control group. Similar results were obtained when serum calcium level was evaluated. Mean serum magnesium level (1.53 +/- 0.29 mg/dl) was significantly low in cases of pre-eclampsia, while it was 1.79 +/- 0.25 mg/dl in patients with gestational hypertension and 2.19 +/- 0.2 mg/dl in control group. Patients having gestational hypertension along with increased micro-albumin creatinine ratio had significantly low mean magnesium level (1.68 +/- 0.1 mg/dl) when compared with gestational hypertensive patients with normal microalbumin creatinine ratio (serum magnesium level 1.87 +/- 0.1 mg/dl).     

Cyclosporine treatment in idiopathic membranous nephropathy nephrotic syndrome in adults: a retrospective study spanning 15 years

Background  Cyclosporine is effective in treating nephrotic syndrome (NS) with idiopathic membranous nephropathy (IMN) in adults. But high relapse rate remains a major concern. The way to manipulate cyclosporine is inconclusive. The aim of this study was to introduce the way how to titrate the cyclosporine to maintain complete remission without relapse.

Methods  Patients with biopsy-proven IMN with NS treated with cyclosporine for at least 1 month from 1996 to 2011 at Peking Union Medical College Hospital were reviewed.

Results  Mean age of the 51 eligible patients was 52 years, with 39 men. Mean proteinuria was (7.47±3.14) g/d, serum albumin (24.50±6.29) g/L, and serum creatinine (82.62±21.18) mmol/L. Cyclosporine was commenced at a mean dose of (3.46±0.63) mg·kg^-1·d^-1. Oral prednisone (0.40±0.29) mg·kg^-1·d^-1 was given concomitantly in 38 patients. Cyclosporine was administered for a median of 16 months (range 1–93 months) and stopped in non-responders by month six. By month 3 (n=47), the number in complete remission (CR) and partial remission (PR) was 3 and 24, which shifted to 12 and 17 by month 6 (n=41). Male gender, heavy proteinuria, low serum albumin level, and high serum creatinine level were significant determinants in poor response by month six (P <0.05 in all variables compared with responders). There was a significant reversible serum creatinine increase within 25% during month 3 to 12 (P <0.05 in all variables compared with baseline value). Eleven patients maintained cyclosporine for more than 24 months with a cyclosporine dose of (1.04±1.06) mg·kg^-1·d^-1. Nine patients were in CR. Renal function, systolic and diastolic blood pressure remained stable. Renal impairment (>30% rise of serum creatinine), secondary infection, hypertension, gingival hyperplasia and liver impairment occurred in 6, 4, 10, 4, and 1 patients, respectively.

Conclusions  The observation time for cyclosporine to effectively induce CR of NS in IMN adults should be at least six months. Long-term and low-dose of cyclosporine therapy is safe and effective to maintain CR in those responders.

     

How Robust are our Methods of Detecting Impaired Glomerular Filtration Rate in the Intensive Care Unit?

Background

Serum creatinine is not a sensitive marker to assess early loss of renal function in acute kidney injury. Timed creatinine clearance and several formula used to predict glomreular filtration rate have not been validated.

Methods

In a prospective observational study in 50 adult patients admitted to the intensive care unit with apparent normal renal function, we assessed the glomerular filtration rate by the formula methods and timed creatinine clearance.

Result

The mean serum creatinine was 0.77mg/dl, SD ± 0.15 (range 0.5-1.14 mg/dl). The mean measured creatinine clearance was 87.15 ml/min/1.73m², SD ± 20.5 (range 56.9-137 ml/min/1.73m²). In 25 (50%) patients, one hour urinary creatinine clearance was <80 ml/min/1.73m² and in two (4%) patients, the creatinine clearance was <60 ml/min/1.73m². Spearman correlation coefficient and regression analysis revealed a statistically significant correlation for the Cockcroft-Gault and predictive equations when compared with measured creatinine clearance. The differences between the predictive equations and creatinine clearance, as illustrated by the ±95% confidence interval in the Bland-Altman graphs was very significant [Cockcroft- Gault = −40.3 to 17.7 ml/min/ 1.73m², Modification of Diet in Renal Disease equation = −46.2 to 30.6 ml/min/1.73m² and the simplified Modification of Diet in Renal Disease equation = −72.8 to 24.8 ml/min/1.73m²].

Conclusion

Formula methods and creatinine clearance are more sensitive than serum creatinine in detecting early phase of acute kidney injury. However, there is no agreement between these methods of glomerular filtration rate estimation.Key Words: Acute kidney failure, Glomerular filtration rate     

Clinical and pathological features of six cases of sarcoidosis presenting with renal failure

Six patients with biopsy-proven renal sarcoidosis presented with renal failure of unknown origin; in none was the diagnosis of sarcoidosis initially considered. The serum creatinine concentration at the time of presentation ranged from 265 to 1380 μmol/l (3.0 to 15.6 mg/dl), with a mean of 787 μmol/l (8.9 mg/dl). Although only two patients were hypercalcemic at the time of presentation, the 24-hour urinary excretion of calcium was increased in three of the four patients in whom it was measured, and renal calculi were present in one case. Renal biopsy revealed interstitial nephritis and tubular atrophy in all cases, as well as nephrocalcinosis in three cases and noncaseating granulomas negative for acid-fast bacilli in four cases. In each patient steroid therapy led to a rapid improvement in renal function (mean post-treatment serum creatinine level 274 μmol/l [3.1 mg/dl]). The follow-up period ranged from 8 months to 8 years (mean 3.0 years). In three patients renal function remained stable with low-dose steroid therapy. In two cases recurrent hypercalcemia and deteriorating renal function accompanied steroid withdrawal but resolved with its reinstitution. In one additional case reversible deterioration in renal function accompanied tapering of the steroid dose; however, there was no hypercalcemia.     

狼疮性肾炎病理与临床特征相关性研究:49例报告

目的 探讨狼疮性肾炎病理与临床活动性以及实验室检查的关系.方法 对49例狼疮性肾炎患者进行肾活检及病理分型,分析各病理类型的临床活动性,实验室检查以及肾脏病理特点的关系.结果 所有患者均有病理学异常,Ⅳ、Ⅴ型临床多表现为肾病综合症,而Ⅱ、Ⅲ型多以隐匿性肾炎为主要表现;NIH、BI指标不仅能反应病理损伤情况,且与临床重要指标之间具有显著相关性;几乎所有病理积分以及重要的临床指标均提示Ⅳ型狼疮的活动性较强.结论 狼疮性肾炎的病理类型与临床活动性、实验室检查有一定联系;根据狼疮性肾炎的临床活动性积分、实验室检查可以大致推测其病理类型,估计肾损害的严重程度.     

Effect of losartan treatment on the proteinuria in normotensive patients having proteinuria due to secondary amyloidosis

Secondary amyloidosis (AA amyloidosis) is a well known cause of nephrotic syndrome and renal failure. Several studies in patients with nephrotic syndrome have suggested a beneficial effect of angiotensin-converting enzyme inhibitors (ACEI). Angiotensin II (ATII) receptor antagonists effect on the long term is not known. In this study, we intended to study the effect of losartan, as an ATII receptor antagonist, on proteinuria and renal functions in patients with normotensive secondary amyloidosis. In total 44 patients with biopsy proven AA amyloidosis associated with nephrotic proteinuria were included. The first group of patients (n=22) was treated with losartan 50 mg/day. The second group of patients (n=22) did not receive any specific antiproteinuric treatment. Urinary protein loss was effectively lowered by losartan from 4.38 +/- 1.0 to 2.8 +/- 0.61 g/day (p<0.0001), whereas the control group showed a slight fall in proteinuria as 4.21 +/- 1.06 to 4.12 +/- 1.07 g/day (p = 0.176). Hypoalbuminemia improved significantly from 2.52 +/- 0.69 to 2.78 +/- 0.46 g/dl (p = 0.004), in the losartan group, whereas serum albumin had fallen in the control group from 2.44 +/- 0.57 to 2.27 +/- 0.41 (p = 0.041). Serum creatinine increased in the control group from 1.52 +/- 0.42 to 2.39 +/- 0.51 mg/dl (p<0.0001), and in the losartan group from 1.59 +/- 0.50 to 1.84 +/- 0.6 mg/dl (p<0.001), after 24 months of treatment. The ATII receptor blocker losartan is effective in protecting against the progression of nephropathy due to AA amyloidosis. Symptomatic treatment of proteinuria with losartan is therefore to be considered, especially with severe proteinuria even in normotensive patients.     

狼疮性肾炎病理类型与临床表现及实验室指标的相关性

目的探讨狼疮性肾炎(LN)病理与临床表现及实验室指标的相关性。方法对99例LN患者病理类型、临床表现、实验室指标进行回顾性分析,总结病理类型、临床表现、实验室指标之间的相关性。结果 LN病理类型以Ⅳ+Ⅴ型最为常见,占38.10%,其次为Ⅳ型26.30%,Ⅴ型为16.20%,Ⅱ型最少,占3.03%;临床肾损害主要以肾病综合征型(51.52%)、肾炎综合征型(36.36%)为主。最常见的肾外临床表现为血液系统损伤(80.81%),其次为浆膜炎(56.57%),而神经系统损伤少见(5例)。Ⅳ+Ⅴ型血肌酐最高,Ⅲ+Ⅴ型24 h尿蛋白定量最高,Ⅳ型血红蛋白最低,Ⅱ型24 h尿蛋白定量明显比其他各病理类型低(P0.05)。SLEDAI评分Ⅳ型最高,Ⅱ型最低,且Ⅳ型、Ⅳ+Ⅴ型评分明显高于Ⅱ型(P0.05)。结论狼疮性肾炎的病理类型与临床表现、实验室指标存在一定相关性,肾活检术对于判断肾脏病变程度、活动性,指导进一步诊治及判断预后具有重要意义。     

妊娠急性脂肪肝17例临床分析

目的 妊娠急性脂肪肝(AFLP)是一种特发的、少见的妊娠期并发症,病死率高.为了加强对AFLP的认识,提高早期诊断和治疗水平,时该院17例AFLP患者进行回顾分析.方法 对2005年1月～2011年12月入住该科的17例妊娠急性脂肪肝患者的临床表现、治疗及预后进行回顾性分析.结果 70.58％的病例发生在孕35-38周.多数患者早期有明显的消化系统症状:胃肠道不适、黄疸等,所有患者均出现黄疸,胆红素升高较转氨酶升高更加明显,64.70％的病例早期出现肾功能损害,凝血功能检查可见纤维蛋白原明显下降(占88.23％),抗凝血酶原Ⅲ均有不同程度的下降.一经诊断,所有患者及早终止妊娠(100％),大部分患者接受血浆置换(88.2％).孕产妇抢救成功率94.11％,死亡率5.88％,88.23％的新生儿出现窘迫,新生儿病死率5.88％.结论 妊娠晚期出现消化道症状,伴肝肾功能、凝血功能异常,应警惕妊娠急性脂肪肝.早期诊断,尽快终止妊娠,加强综合治疗,尽早行血浆置换治疗可能是治疗该病的关键.     

62例肾病综合征临床病理分析

目的探讨肾病综合征患者临床表现与肾脏病理的关系。方法对符合尿蛋白〉3．5g／24h及血清白蛋白〈30g／L诊断标准的62例肾病综合征患者进行经皮肾活检术，通过光镜、免疫病理及电镜检查明确病理分型。结果62例肾病综合征患者中常见的病理类型为系膜增生性肾小球肾炎（25．81％）、微小病变（17．74％）、IgA肾病（11．29％）、膜性肾病（8．07％）和狼疮性肾炎（27．42％），通过肾活检纠正5例临床诊断。结论肾活检病理对肾病综合症征诊断、治疗及预后评估有重要意义。     

Clinicopathologic study of lupus nephritis

Needle biopsies of kidney were done in 35 cases of systemic lupus erythematosus (SLE) with renal lesions. The lupus nephritis were classified according to WHO classification and were correlated with response to therapy and prognosis. Detailed clinical features, routine haematological, biochemical tests (e.g., serum urea, creatinine, total protein and albumin, cholesterol, etc), examination of urine (degree of proteinuria and cells) and occurrence of various auto-antibodies e.g., antinuclear antibody (ANA), anti double stranded DNA (anti DsDNA) by enzyme immunoassay (EIA) method, LE cells and rheumatoid factor (RF) were studied in all cases. Clinically hypertension was present in 19 (54.3%) cases and nephrotic range of proteinuria was detected in 20 (57.2%) cases. ANA was found in 31 (88.5%) cases, anti DsDNA 24 (68.5%) and LE cells were detected in 25 (71.5%) cases. RF was detected in 2 (5.7%) cases. Histologically the most frequent lesions were class IV occurring in 15 cases (42.8%) with initial complete remission achieved only 4 cases by immunosuppressive therapy. Active lesions were also most frequent in this class. Class III lesions were found in 8 (22.8%) cases with 6 cases had complete remission. The best prognosis was noted in class II cases with 4 out of 5 (14.3%) cases had complete remission. Class V lesions were found in 6 (17.2%) cases with complete remission achieved in 3 cases. Only one patient presented with class VI lesion. RF positive cases had milder renal lesions.     

The significance of arterial hypertension at the onset of clinical lupus nephritis.

The prognostic importance of hypertension at the onset of clinical lupus nephritis is not well established. We studied retrospectively 44 patients with lupus nephritis in order to ascertain the prevalence of hypertension at presentation and to investigate a possible association between hypertension and renal functional impairment. A correlation was also sought between hypertension and histological class of lupus nephritis. Hypertension was graded as mild (diastolic 95-99 mmHg), moderate (100-114) or severe (> 115). Impaired renal function (creatinine > 120 mumol/l) was graded as mild (120-200 mumol/l), moderate (200-350 mumol/l), or severe (> 350 mumol/l). Histological class and the presence of hypertensive renal vascular lesions was recorded. The prevalence of hypertension was 38%. There were 17 hypertensives and 27 normotensives. The incidence of renal impairment was greater in the hypertensives, 47% vs 18.5% (p = 0.04). Mean serum creatinine was also higher higher in this group (p = 0.02). The presence of hypertensive renal vascular lesions identified a high-risk subgroup who had a higher incidence of renal functional impairment and worse renal function than the hypertensive group as a whole. Even at an early stage, hypertension and hypertensive renal vascular lesions correlated well with renal functional impairment. Aggressive treatment of hypertension is therefore essential in early lupus nephritis in order to prevent further deterioration of renal function as the disease evolves.     

Treatment and renal outcome of lupus nephritis: single center experience

Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease with renal involvement being one of the most frequent and serious manifestations of the disease. The aim of the study is to analyze the treatment and renal outcome of patients with lupus nephritis (LN) WHO class III and IV on cyclophosphamide (CYC). We retrospectively identified 41 patients with biopsy proven LN who was given either oral or intravenous CYC. The male: female ratio was 4:37; with a mean age of 31.7 +/- 9.8 years at presentation. 36 patients (87.8%) had LN class IV and only five patients (12.2%) with LN class III. The mean serum creatinine at presentation was 87.4 +/- 37.2 micromol/L with mean follow-up of 84 +/- 78 months. A total of 30 patients (73.2%) completed 12 courses of IV CYC and one patient (2.4%) completed three months of oral CYC. 71.0% (n = 22) had complete response (CR), 25.8% (n = 8) had partial response and 3.2% (n = 1) had no response (NR). Of the remaining 11 patients, two patients (4.9%) died during the treatment, three patients (7.3%) defaulted treatment and five patients (12.2%) are still receiving ongoing treatment. Presence of hypertension (p < 0.003) and evidence of chronicity on renal biopsy (p < 0.016) were significantly correlated with the progressive deterioration of renal function in our population. In conclusion, hypertension and evidence of chronicity on renal biopsy, proved to be risk factors for progressive renal impairment in our study population. The achieved global outcome can be considered good.     

慢性肾功能不全患者的病理类型分析

目的分析肾活检时表现为慢性肾功能不全患者（Scr≥130μmol/L）的患者病理类型及特点。方法选择我院2006年1月～2008年12月行肾脏活检时表现为血清肌酐升高（Scr≥130μmol/L）的所有慢性肾脏病患者共104例作为研究对象,分析其临床和病理特点。同时重点分析了增生硬化型IgA肾病的特点。结果 104例慢性肾脏病患者在肾活检时表现为肾功能异常,占同期肾活检患者的11.9%。这些患者的平均血清肌酐（235.11±114.4）μmol/L。临床诊断主要为：慢性肾小球肾炎63例,肾病综合征27例,系统性血管炎4例,系统性红斑狼疮3例。其中78例（75.0%）患者有高血压。病理类型主要表现为IgA肾病（46.2%,其中有70.8%的患者主要表现为增生硬化性肾炎）,其次是间质性肾炎,系膜增生性肾小球肾炎,新月体肾炎,局灶节段肾小球硬化,IV型狼疮性肾炎。其中,增生硬化型的IgA肾病患者血压升高更为突出,但是尿蛋白量更少。结论表现为慢性肾功能不全的患者病理上主要为IgA肾病,其中增生硬化性肾炎是主要病理表现,其次是肾小管间质病变。慢性病变是主要的病理特点。     

Intrathecal injection with methotrexate plus dexamethasone in the treatment of central nervous system involvement in systemic lupus erythematosus

Objective To investigate the effect of intrathecal injection (IT) with methotrexate (MTX) plus dexamethasone (DXM) in treating central nervous system involvement in syste mic lupus erythematosus (CNS lupus). Methods Twenty- four CNS lupus patients that were refractory to conventional steroid the rapy were selected for IT with MTX 10-20 mg plus DXM 10-20 mg. The effects an d side effects of IT were closely observed. Results The symptoms and signs of 22/24 (91. 7%) CNS lupus patients receiving IT improve d considerably. Cerebrospinal fluid pressure,protein and WBC levels declined fr om 201. 5±155. 4 mm H2O, 145. 2±87. 6 mg/dl and 25. 1±14. 3/mm［3］ to 128 . 7±108. 1 mm H2O, 60. 8±38. 3 mg/dl and 6. 8±2. 1/mm［3］ respective ly. Transient side effects were observed in 4 patients: 1 with itching sensatio n of lower limbs, 2 with headache and 1 with incontinence. Conclusion IT with MTX plus DXM is a promising method for treating CNS lupus and deserves further investigation.     

Ophthalmic manifestations in people living with HIV attending a tertiary care centre of Eastern India

A cross-sectional study was undertaken to evaluate ophthalmic lesions in human immunodeficiency virus-infected individuals in eastern part of India. One hundred and seventy-five Indian patients attending one tertiary care centre in Kolkata, were included in the study. Ophthalmic manifestations were found in 29.14%. Of them 64.70% had posterior segment lesion, 23.52% had neuro-ophthalmic lesion, 19.60% had anterior segment lesion, 15.69% had adnexal lesion. Human immunodeficiency virus retinopathy was the commonest ophthalmic lesion involving 23 eyes. Cytomegalovirus retinitis was found in only 10 eyes. Ophthalmic lesions were less common in this study than reported in earlier literature in India and abroad.     

Improved glycaemic control with no weight gain: a 26-week, open label, non-randomised, non-interventional observational study on type 2 diabetes subjects using insulin detemir

The aim of this study was to evaluate the weight change from baseline while using insulin detemir in subjects with type 2 diabetes mellitus under normal clinical practice conditions. It was a multicentre, open label, non-randomised, non-interventional, observational, safety and efficacy study in subjects using insulin detemir for the treatment of type 2 diabetes mellitus. In this study, the mean body weight decreased marginally by -0.8 kg at the end of week 26 from baseline. Change in mean body weight during the study was not statistically significant (p > 0.05). There was a statistically significant (p < -0.05) change in waist circumference (-0.7 cm) from baseline at week 26. Mean fasting plasma glucose reduced significantly (p < 0.0001) from 199.1 mg/dl at initiation of insulin detemir to 141.3 mg/dl at week 13 and 115.8 mg/dl at week 26. Mean HbA1c reduced significantly (p < 0.0001) from 9.2% at initiation of insulin detemir to 7.8% at week 13 and 7.2% at week 26. Insulin dose changed marginally from the baseline (15.1 units) to week 26 (15.3 units). Majority of the subjects (89%) were on once daily insulin detemir. Before initiating insulin detemir proportion of subjects experiencing at least one episode of hypoglycaemia during the past four weeks was 8.8% (n = 884). It was reduced 2.4% (n = 241) at week 13 and 1.6% (n = 164) at week 26 following initiation of insulin detemir. There were no major nocturnal hypoglycaemic episodes during 26 weeks of insulin detemir therapy. In conclusion, this study indicates that insulin detemir is safe, effective and weight neutral.     

Exertional heat stroke: the runner's nemesis.

Heat stroke in distance runners is increasing in frequency. A case is reported of a 41-year-old man who collapsed during a 10-km "fun run" held when the temperature was 31.6 degrees C and the humidity 80%. Acute renal failure (serum creatinine level 1530 mumol/l [17.3 mg/dl]), rhabdomyolysis, disseminated intravascular coagulation and hepatic damage complicated the clinical picture. Repeated peritoneal dialysis and one cycle of hemodialysis because of a very high serum level of uric acid (1.23 mmol/l [20.7 mg/dl]) were required. Although the illness was prolonged, recovery was almost complete, and 4 months after the man's collapse the serum creatinine level had fallen to 133 mumol/l (1.5 mg/dl).     

Lupus nephritis. Clinicopathological correlation

OBJECTIVE: To classify all renal biopsies of lupus nephritis patients presenting in the last 10 years, according to the modified World Health Organization (WHO) classification using the facilities of light, fluorescent, and electron microscopy. To assess the activity and chronicity indices of renal biopsies according to the National Institute of Health protocol, and to correlate the histological findings with the clinical features of the patients presented up to the time of biopsy. METHODS: Seventy-eight patients with lupus nephritis, biopsied over 10 years between January 1995 to December 2005 in King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia were reviewed by 2 histopathologists with the assistance of a nephrologist. RESULTS: The predominant histological type was WHO class IV. Patients of this class were more commonly associated with microhematuria, elevated proteinuria, and renal insufficiency. Active and chronic lesions were more likely to occur in patients of class III/IV. These patients were also more likely to have evidence of clinical renal disease than patients in class II. There was a significant association between nephrotic syndrome and class V lupus nephritis. CONCLUSION: Although the clinical and pathological correlation demonstrated a significant relationship between underlying histopathology and the clinical course of the patient, however, the biopsy findings did not uniformly correlate with the clinical features. Moreover, the status prediction of lupus nephritis patients based on clinical information alone was significantly enhanced by information obtained from renal biopsy.