Lupus nephritis is diagnosed by either the presence of proteinuria (>0.5 g/day), active urinary sediment (with red blood cell, granular, tubular and/or mixed casts), or an unexplained rise in serum creatinine in patients with systemic lupus.

The diagnosis of SLE will be according to the 1997 American college of Romatology revised criteria (Hochberg 1997).these group will be taken as a control group

a group of age and sex matched healthy individuals will be taken as a control group.

Lupus Nephritis

Ultrasound evaluation will be performed for all patients as well as healthy individuals.in patients with lupus nephritis,the ultrasound evaluation will be performed the 24 h prior to the renal biopsy . In the maximum long-axis section images, the largest diameter and width of each kidney will be measured. The participants will be scanned in a supine or decubitus position to achieve an ultrasound beam as close to parallel to the blood flow direction in the intrarenal artery as possible. RRI is measured as :
RRI = (peak systolic velocity - end diastolic velocity ) / peak systolic velocity. the average of three measurements will be taken.

Doppler ultrasonography of renal arteries

Renal biopsy is a medical procedure in which a small piece of kidney is removed from the body for examination, usually under a microscope. Microscopic examination of the tissue can provide information needed to diagnose, monitor or treat problems of the kidney.Renal biopsy will be taken according American college of Romatology guidelines 2012.The renal biopsy samples were evaluated according to the Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis 2017. the actvity index and chronicity index will be calculated.

Renal biopsy

blood sample will be taken to measure blood urea nitrogen (BUN) and serum creatinine(S Cr). estimated glomerular filtration rate (eGFR) will be measured using CKD-EPI Equation.These investigations will be done at the beginning of the study and every month for sex months for each patient to determine degree of response to treatment .

kidney function tests

The 24-hour urine protein test checks how much protein is being spilled into the urine.Urine samples are collected in one or more containers over a period of 24 hours. The containers are kept in a cool environment and then sent to a lab for analysis. Specialists then check the urine for protein.This investigations will be done at the beginning of the study and every month for sex months for each patient to determine degree of response to treatment .

The 24-hour urine protein test

A complete blood count is a blood panel that gives information about the cells in a patient's blood, such as the cell count for each blood cell type and the concentrations of hemoglobin.

complete blood counting (CBC)

Renal Resistive Index as a Marker of Severity and Treatment Outcomes in Lupus Nephritis

Measurement of Renal Artery Resistive Index as a Predictor of Severity of Lupus Nephritis and Its Response to Treatment

the sum of RRI values in each group divided by the number of individuals in each group

Renal Resistive Index will be measured as :RRI = (peak systolic velocity - end diastolic velocity ) / peak systolic velocity .chronicity index score in renal biopsy will be calculated according to the Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis 2017. Result of renal biopsy will be reported within one weak.Correlation between RRI and chronicity index using correlation tests using SPSS version 20; pearson correlation test if the data are normally distributed and spearman correlation test if the data aren't normally distributed

pathological RRI(RRI>0.7) .Renal biopsy will be evaluated according to the Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis 2017. There are 6 classes of lupus nephritis in renal biopsy. Number of patients in each class will be identified. the sum of RRI values in each class divided by the number of patients in each class

measurement of RRI in each patient with lupus nephritis . Blood sample from the same patient to measure blood urea nitrogen (BUN), serum creatinine(S Cr) and estimated glomerular filtration rate (eGFR) (using CKD-EPI Equation)

RRI will be measured for every patient with lupus nephritis at the beginning of the study. the patients will be followed for 6 months .BUN,S Cr , eGFR and and 24 h urinary protein excretion will be measured at the beginning of the study and every month for sex months to determine degree of response to treatment in patients with pathological RRI(0.7) compared to those with normal RRI.

RRI will be measured for every patient of lupus nephritis at the beginning of the study.Hemoglobin level will be measured at the beginning of the study and every month for sex months and the mean will be calculated

Yasser Abd Elmawgood Fysal Ibrahim

assistant lecturer

Assiut University

Resistant Hypertension

Division of Cardiology Severance Cardiovascular Hospital

Development of Diagnostic and Treatment Strategy for Resistant Hypertension

Composite of cardiovascular death, myocardial infarction, stroke, admission for heart fails

Start dialysis or doubling of serum creatinine

Target organ damage: LVH confirmed by echocardiography or EKG; carotid femoral PWV≥ 12m/s; microalbuminuria (Urine albumin-creatinine ratio ≥30 mg/g)

Target blood pressure: Achievement of BP below 130/80 or 140/90 mmHg

Yonsei University

Maximal recommended dose of ramipril "Altace®" (10 mg/d) given as an active comparator for 12 week.

Perindopril "Coversyl®" at maximal recommended dose (8 mg/d) as experimental therapy for 12 weeks.

Diabetes

Microalbuminuria

Comparison of two renin angiotensin aldosterone inhibitors

ramipril

perindopril

Sunnybrook Health Sciences Centre

Perindopril vs Ramipril for Persistence in MAU Reduction Study

24 hour, day, and night systolic and diastolic blood pressure

Sheldon Tobe

Staff Physician

Servier

Renal blood flow before and after exposure to iodinated contrast agent (perflutren) also known as Definity will be measured using contrast enhanced ultrasound (CEUS).

Contrast Induced Acute Kidney Injury

Contrast Enhanced Ultrasound is performed during continuous intravenous infusion of Definity (drug) to assess changes in renal blood flow during the study

perflutren

University of Virginia Health System

Monitoring Renal Blood Flow With Contrast Enhanced Ultrasound During Coronary Angiogram

Monitoring Renal Blood Flow Using Contrast Enhanced Ultrasound in Predicting Acute Kidney Injury After Exposure to Iodinated Contrast Agent

Correlation between changes in renal blood flow measured by contrast ultrasound and occurrence of AKI.

renal artery obstruction/albumin

Renal Resistive Index as a Marker of Severity and Treatment Outcomes in Lupus Nephritis

Development of Diagnostic and Treatment Strategy for Resistant Hypertension

Perindopril vs Ramipril for Persistence in MAU Reduction Study

Monitoring Renal Blood Flow With Contrast Enhanced Ultrasound During Coronary Angiogram

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