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      Profil clinique et survie des patients avec néphrite lupique en néphrologie au Cameroun: étude monocentrique Translated title: Clinical profile and survival of patients with lupus nephritis in the department of nephrology in Cameroon: a single-center study

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          Abstract

          Introduction

          le pronostic de la néphrite lupique en Afrique Subsaharienne est mal connu. Notre objectif était de décrire le profil clinique et la survie des patients avec une néphrite lupique suivis en néphrologie.

          Méthodes

          nous avons mené une étude de cohorte rétrospective mono centrique sur 5 ans. Les patients avec une néphrite lupique nouvellement diagnostiquée et un suivi de plus de 3 mois ont été inclus. La néphrite lupique était définie par la présence de signes d´atteinte glomérulaire, confirmée ou non à l´histologie. Nous nous sommes intéressés aux données cliniques, à l´évolution sous traitement et à la mortalité.

          Résultats

          au total, 20 patients ont été inclus dont 17 femmes (85%). La médiane [IIQ] d´âge était de 27[18-37] ans. Le lupus érythémateux systémique était diagnostiqué concomitamment à la néphrite lupique chez 90% (n=18) des patients. Douze (60%) patients avaient un syndrome néphrotique. Les classes prolifératives actives étaient les plus fréquentes (n=5, 72%). Quinze patients (75%) ont bénéficié d´une induction et la rémission était obtenue chez 6 (30%). A 12 et 24 mois, les survies rénales et globales étaient respectivement de 68,6% et 49%; de 57,8% et 31%. L´absence de rémission était associée au mauvais pronostic.

          Conclusion

          la néphropathie lupique est un mode de révélation fréquent du lupus dans notre contexte. Son pronostic est sombre et plus de la moitié des patients décèdent ou sont en insuffisance rénale terminale dans les 24 mois.

          Translated abstract

          Introduction

          prognosis of lupus nephritis in sub-Saharan Africa is poorly known. The purpose of this study is to describe the clinical profile and survival of patients with lupus nephritis treated in the Department of Nephrology.

          Methods

          we conducted a single-centre retrospective cohort study over a period of 5 years. Patients with newly diagnosed lupus nephritis and followed-up for more than 3 months were included in the study. Lupus nephritis was defined as the presence of signs of glomerular damage, whether histologically confirmed or not. We investigated clinical data, treatment effects, and mortality rates.

          Results

          a total of 20 patients were enrolled in the study, including 17 women (85%). The average age [IQ] of patients was 27 [18- 37] years. Systemic lupus erythematosus was diagnosed concomitantly with lupus nephritis in 90% (n=18) of patients. Twelve (60%) patients had nephrotic syndrome. Active proliferative classes were mainly reported (n=5, 72%). Fifteen patients (75%) received induction therapy and remission was obtained in 6 (30%) patients. At 12 and 24 months, renal and global survival was 68.6% and 49%, and 57.8% and 31%, respectively. The absence of remission was associated with poor prognosis.

          Conclusion

          lupus nephropathy is a common way of revealing lupus in our context. Prognosis is poor, and more than half of patients die or develop end-stage renal disease within 24 months.

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          Most cited references20

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          2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus

          To develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). This international initiative had 4 phases: 1) Evaluation of anti-nuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort and a patient survey. 2) Criteria reduction by Delphi and nominal group technique (NGT) exercises. 3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. 4) Refinement of weights and threshold scores in a new derivation cohort of 1001 subjects and validation compared to previous criteria in a new validation cohort of 1270 subjects. The 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in 7 clinical (constitutional, hematologic, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and 3 immunological (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared to 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics (SLICC) 2012 criteria. These new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered and weighted criteria reflect current thinking about SLE and provide an improved foundation for SLE research.
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            Lupus nephritis

            Lupus nephritis (LN) is a form of glomerulonephritis that constitutes one of the most severe organ manifestations of the autoimmune disease systemic lupus erythematosus (SLE). Most patients with SLE who develop LN do so within 5 years of an SLE diagnosis and, in many cases, LN is the presenting manifestation resulting in the diagnosis of SLE. Understanding of the genetic and pathogenetic basis of LN has improved substantially over the past few decades. Treatment of LN usually involves immunosuppressive therapy, typically with mycophenolate mofetil or cyclophosphamide and with glucocorticoids, although these treatments are not uniformly effective. Despite increased knowledge of disease pathogenesis and improved treatment options, LN remains a substantial cause of morbidity and death among patients with SLE. Within 10 years of an initial SLE diagnosis, 5-20% of patients with LN develop end-stage kidney disease, and the multiple comorbidities associated with immunosuppressive treatment, including infections, osteoporosis and cardiovascular and reproductive effects, remain a concern. Clearly, early and accurate diagnosis of LN and prompt initiation of therapy are of vital importance to improve outcomes in patients with SLE.
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              Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000-2004.

              Systemic lupus erythematosus (SLE) and lupus nephritis (LN) disproportionately affect individuals who are members of racial/ethnic minority groups and individuals of lower socioeconomic status (SES). This study was undertaken to investigate the epidemiology and sociodemographics of SLE and LN in the low-income US Medicaid population.
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                Author and article information

                Contributors
                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                14 March 2022
                2022
                : 41
                : 205
                Affiliations
                [1 ]Hôpital Général de Douala, Douala, Cameroun,
                [2 ]Faculté de Médecine et des Sciences Biomédicales de Yaoundé, Yaoundé, Cameroun,
                [3 ]Hôpital Général de Yaoundé, Yaoundé, Cameroun,
                [4 ]Faculté de Médecine et des Sciences Pharmaceutiques de Dschang, Dschang, Cameroun,
                [5 ]Faculté de Médecine et des Sciences de la Santé de Bamenda, Bamenda, Cameroun,
                [6 ]Faculté de Médecine et des Sciences Pharmaceutiques de Douala, Douala, Cameroun
                Author notes
                [& ] Corresponding author: Hermine Danielle Fouda Menye Ebana, Hôpital Général de Douala, Douala, Cameroun. mendjouf@ 123456yahoo.fr
                Article
                PAMJ-41-205
                10.11604/pamj.2022.41.205.28844
                9146594
                35685107
                c375094f-0c8a-413b-9cde-2ab985071596
                Copyright: Hermine Danielle Fouda Menye Ebana et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 March 2021
                : 26 January 2022
                Categories
                Research

                Medicine
                néphrite lupique,syndrome néphrotique,rémission,survie,lupus nephritis,nephrotic syndrome,remission,survival

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