الفهرس 
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Abstract
Systemic lupus erythematosis (SLE) is a devastating autoimmune disease that can result in substantial morbidity and mortality. Diagnosis and treatment of SLE are clinical challenges. Patient presentation and response to therapy are heterogeneous because of the complex immune dysregulation that results in SLE disease pathogenesis. Lupus nephritis (LN) is a frequent and severe manifestation of SLE affecting approximately 40% of patients with lupus. It represents a major risk factor for morbidity and mortality, and 10% of patients with LN will develop end-stage kidney disease (ESKD).
Color Coded Doppler Ultrasound (CCDUS) allows non-invasive method for investigating renal hemodynamics. Renal resistive index (RI) measured using CCDUS reflects intrarenal vascular resistance. RI is an essential parameter in renal Doppler US and integrates arterial compliance, pulsatility and peripheral resistance.
This study represents one of the studies that aimed to assess the role of resistive RI as a non-invasive parameter in detecting renal affection in SLE patients.
The present study included 30 patients 15 SLE with no renal affection, their ages ranged between 16-49 years with a mean of 33.13 ± 11.69 years and 15 SLE lupus nephritis patients, their ages ranged between 21- 45 years with a mean age of 30.0 ± 12.06, who were selected from outpatient clinic of Physical Medicine, Rheumatology and Rehabilitation department and outpatient clinic of Ain Shams University Hospitals, diagnosed according to ACR criteria 2019 for SLE.
The control group composed of 15 healthy age and gender matched subjects without any risk factors of chronic diseases.
All patients were subjected to full medical history taking, clinical examination, Assessment of disease activity (SLEDAI), laboratory investigations as CBC, ESR, CRP, serum creatinine, BUN, C3, C4, anti-ds DNA, ANA, complete urine analysis, 24 hours urinary proteins, eGFR and protein/creat ratio. All patients and controls were subjected to CDUS to detect renal parenchymal echogenicity, renal length and outline and to measure RI bilaterally.
The present study revealed:
-Statistically significant increase in both SLEDAI and renal SLEDAI scores in the group of lupus nephritis.
-Statistically significant increase in serum BUN, creat, urinary pus cells, RBCs, casts and proteins, 24 hours urinary proteins and protein/creat ratio in the group of lupus nephritis.
-Statistically significant increase in both right and left resistive indices in the group of lupus nephritis than the other group.
- There was statically significant Positive correlation Between average RI (velocity systolic-velocity diastolic/velocity systolic) and SLEDAI, rSLEDAI, sr.creat (mg/dl), BUN (mg/dl), 24 hrs urinary protiens (in mg/24hrs) and P/C ratio(mg/mg), while there was statically significant negative correlation between average RI and eGFR.
-There was no statically significant correlation Between RI and Age, Disease duration in years, HGB (g/dl), PLTs (10^3/micro L), WBCS (10^3/micro L), ESR (mms), CRP (mg/l), ANA (IU/ml), Anti DNA (IU/ml), C3 (mg/dl) and C4 (mg/dl).
-There was highly statistically significant difference between SLE without nephritis and SLE with nephritis regarding renal echogenicity, while there was no statistically significant difference between SLE without nephritis and SLE with nephritis regarding Renal outline and Renal length.
-Correlation between bilateral renal RI with renal parenchymal echogenicity, renal out line and renal length was statistically significant with renal echogenicity while not statistically significant with renal length or renal outline.
- Relation between renal echogenicity and demographic , laboratory and clinical data was done and was highly statistically significant with rSLEDAI, sr.creat (mg/dl), BUN (mg/dl), 24 hrs urinary proteins (in mg/24hrs) and P/C ratio(mg/mg).
-Our study highlighted that the best cut off point of Rt average RI to detect SLE with nephritis group was found > 0.68 with sensitivity of 86.7%, specificity of 100.0% while the best cut off point of lt average RI to detect SLE with nephritis group was found > 0.7 with sensitivity of 80.0%, specificity of 100.0%.