Maternal and fetal outcomes in pregnant patients with lupus nephritis

Background: Pregnancy in a woman with lupus nephritis (LN) carries a high risk of maternal and fetal morbidity and mortality. This study aims to analyze the effect of LN on maternal and fetal outcomes and lupus activity.Methods: In a single-center, cross-sectional observational study at national hospital Kandy, 32 pregnancies in 23 women with biopsy-proven LN between 2007 and 2019 were analyzed retrospectively.Results: Mean age at pregnancy was 28.4 years (SD=4.8, range 19–38 years). In six women, LN developed during pregnancy, 17 patients were already diagnosed with LN when they became pregnant. A renal biopsy performed 4.6 (SD=3.8) years before pregnancy, showed diffuse LN in 18 (78.3%) and focal LN in 5 (21.7%) cases. At conception, most patients were in complete (43.8%) or partial (21.9%) remission. Therapeutic abortion was performed in 8 pregnancies (indications: renal flares in 5, pre-eclampsia in 3) at a mean period of amenorrhea (POA) of 16.8 weeks (range 8-28 weeks). Spontaneous fetal loss occurred in one pregnancy. Among 23 live births, there were four pre-term deliveries (0.05) between LN histological type, initial clinical presentation and treated hypertension with fetal outcome. No case of neonatal lupus or congenital heart block was noted. During pregnancy, there were five (15.6%) renal flares and two acute kidney injury cases; all were reversible. Eight patients (25%) developed PIHConclusions: Pregnancy induced hypertension is a more commonly encountered complication in pregnancies with lupus nephritis. The fetal outcome is unfavorable in pregnancies with renal flares.

Body composition in lupus nephritis patients

Background: The assessment of body fat distribution is an important evaluation in patients with lupus nephritis (LN), which does not practice routinely. The objectives of this study were to determine the body composition by using bioelectrical impedance analysis and to identify the effects of age, body mass index, disease activity, and corticosteroid therapy on body composition.Methods: This was a single-centered, cross-sectional, and observational study conducted at the nephrology unit, National Hospital Kandy, Sri Lanka. Seventy-nine patients with biopsy-proven LN have participated in the study.Results: There were 79 lupus nephritis patients enrolled in this study. The duration of LN ranged from 8 months to 32 years. The main non-renal clinical manifestations included skin lesions (59%), arthritis (54%), and oral ulcers (48%). The disease activity was low with a mean SLEDAI score of 1.01 (SD=2.3). The body fat (BF) percentage (p=0.002) and subcutaneous fat (SF) percentage (p<0.001) were significantly low in males compared to females. And, BF percentage was significantly low among patients with SLEDAI-2K 6 (p=0.03). Moreover, there were positive correlations found between SLE disease activity with the BMI (p=0.004), body fat percentage (p=0.001), and visceral fat percentage (p=0.001).Conclusions: Females are more prone to have a high mean value of body composition parameters than males in this study. There is a negative influence of the body composition parameters reported against the disease activity among LN patients in Sri Lanka.

Mapping the risk of snakebite in Sri Lanka:a national survey with geospatial analysis

Background There is a paucity of robust epidemiological data on snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of snakebite in Sri Lanka. Methodology/Principal Findings The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country’s population) were surveyed. The crude overall community incidence of snakebite, envenoming and mortality were 398 (95% CI: 356–441), 151 (130–173) and 2.3 (0.2–4.4) per 100000 population, respectively. Risk maps showed wide variation in incidence within the country, and snakebite hotspots and cold spots were determined by considering the probability of exceeding the national incidence. Conclusions/Significance This study provides community based incidence rates of snakebite and envenoming for Sri Lanka. The within-country spatial variation of bites can inform healthcare decision making and highlights the limitations associated with estimates of incidence from hospital data or localized surveys. Our methods are replicable, and these models can be adapted to other geographic regions after re-estimating spatial covariance parameters for the particular region. Author Summary Snakebite is a neglected tropical disease which mainly affects the rural poor in tropical countries. There is little reliable data on snakebite, which makes it difficult to estimate the true disease burden. Hospital statistics underestimate numbers of snakebites because a significant proportion of victims in tropical countries seek traditional treatments. On the other hand, time limited or localized surveys may be inaccurate as they may underestimate or overestimate numbers depending on when and where they are performed. To get a truer picture of the situation in Sri Lanka, where snakebites are an important cause of hospital admission, we undertook an island-wide community survey to determine the number of bites, envenomings and deaths due to snakebite in the previous 12 months. We found that there were more than 80,000 bites, 30,000 envenomings and 400 deaths due to snakebite, much more than claimed by official statistics. There was variation in numbers of bites and envenomings in different parts of the country and, using the data from our survey, we were able develop snakebite risk maps to identify snakebite hotspots and cold spots in the country. These maps would be useful for healthcare decision makers to allocate resources to manage snakebite in the country. We used free and open source software and replicable methods, which we believe can be adopted to other regions where snakebite is a public health problem

Population density map and sampled cluster locations.

<p>Population density map and sampled cluster locations.</p

Reported and estimated snakebites and envenoming bites by sex, age, education, employment and income.

<p>Reported and estimated snakebites and envenoming bites by sex, age, education, employment and income.</p

Parameter estimates from geostatistical model for snakebite incidence.

<p>Parameter estimates from geostatistical model for snakebite incidence.</p

Clinical features recalled by the snakebite victims (N = 695).

<p>Clinical features recalled by the snakebite victims (N = 695).</p

Comparison of probability contour maps for envenoming bites.

<p>Maps represents probability that envenoming bite incidence in each area exceeds: (A) 0.001, (B) 0.00151 (i.e. National rate) and (C) 0.025; contour lines represent P = 0.3 (dash lines) and P = 0.7 (solid lines); green colour area represents the exceedance probability < 0.3 and red colour are represents the exceedance probability > 0.7.</p

Comparison of probability contour maps (PCMs) for snakebite incidence.

<p>pMaps represent probability that snakebite incidence in each area exceeds: (A) 0.003, (B) 0.00398 (i.e. National rate) an (C) 0.005. Contour lines represent P = 0.3 (dash lines) and P = 0.7 (solid lines); green colour area represents the exceedance probability < 0.3 and red colour are represents the exceedance probability > 0.7.</p

Incidence of snakebite and envenoming by province.

<p>Incidence of snakebite and envenoming by province.</p