Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus

Sakamoto, Ana Paula; Silva, Clóvis A.; Islabão, Aline Garcia; Novak, Glaucia V.; Molinari, B.; Nogueira, Paulo César Koch; Pereira, Rosa Maria Rodrigues; Magalhães, Cláudia Saad; Clemente, Gleice; Piotto, Daniela Gerent Petry; Aikawa, Nádia E.; Pitta, Ana C.; Trindade, Vitor; Appenzeller, Simone; Carvalho, Luciana; Rabelo-Júnior, Carlos Nobre; Fonseca, Adriana Rodrigues; Sztajnbok, Flávio; Santos, Maria Carolina dos; Sena, Elisama Araújo de; Moraes, Ana Júlia Pantoja de; Fraga, Melissa Mariti; Robazzi, Teresa Cristina Martins Vicente; Spelling, Paulo F; Scheibel, Iloite Maria; Cavalcanti, André; Matos, Erica Naomi Naka; Guimarães, Luciano Junqueira; Santos, Flávia Patrícia Sena Teixeira; Mota, Licia Maria Henrique da; Bonfá, Eloísa; Terreri, Maria Teresa

doi:10.1007/s00467-022-05811-y

Cited by 9 publications

(4 citation statements)

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“…Decreased eGFR, especially with serum creatinine > 1.5 mg/dl at presentation, and low C3 levels predict ESKD [207,217]. At the same time, LN classes III and IV on biopsy and hypertension at any time are independent risk factors for CKD stage 3 or higher [215].…”

Section: Follow-up and Prognosismentioning

confidence: 99%

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Lupus Nephritis in Children: Novel Perspectives

Pennesi,

Benvenuto

2023

Medicina

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Childhood-onset systemic lupus erythematosus is an inflammatory and autoimmune condition characterized by heterogeneous multisystem involvement and a chronic course with unpredictable flares. Kidney involvement, commonly called lupus nephritis, mainly presents with immune complex-mediated glomerulonephritis and is more frequent and severe in adults. Despite a considerable improvement in long-term renal prognosis, children and adolescents with lupus nephritis still experience significant morbidity and mortality. Moreover, current literature often lacks pediatric-specific data, leading clinicians to rely exclusively on adult therapeutic approaches. This review aims to describe pediatric lupus nephritis and provide an overview of the novel perspectives on the pathogenetic mechanisms, histopathological classification, therapeutic approach, novel biomarkers, and follow-up targets in children and adolescents with lupus nephritis.

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Section: Follow-up and Prognosismentioning

confidence: 99%

“…Decreased proteinuria and normal serum creatinine levels at 1-year follow-up predict positive renal outcomes, together with the use of antimalarials and sustained renal remission [213][214][215][216]. Decreased eGFR, especially with serum creatinine > 1.5 mg/dl at presentation, and low C3 levels predict ESKD [207,217].…”

Section: Follow-up and Prognosismentioning

confidence: 99%

Lupus Nephritis in Children: Novel Perspectives

Pennesi,

Benvenuto

2023

Medicina

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“…Another nationwide observational cohort study of Brazilian cSLE Registry Group included 1528 cSLE of 27 pediatric rheumatology centers. Arterial hypertension [hazard ratio (HR) = 15.42, 95% CI 6.12–38.83] and biopsy-proven proliferative nephritis (HR 2.83, 95% CI 1.70–4.72), increased the risk of CKD, whilst cSLE using antimalarials had 71.0% lower CKD risk compared to those without this medication [23 ▪ ]. In addition, a 20-year study showed that renal relapse was significantly associated with advanced CKD (stages 3–5) and end-stage kidney disease in 95 Chinese childhood lupus nephritis patients.…”

Section: Systemic Lupus Erythematosus Prognosis and Surveillancementioning

confidence: 99%

Updates in the care and management of children and adolescents with systemic lupus erythematosus

Silva,

Aikawa,

Bonfa

2024

Current Opinion in Rheumatology

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Purpose of review This narrative review offers an update of the most important recent articles published in the previous year of childhood-onset systemic lupus erythematosus (cSLE), focusing on care and management. Recent findings Age-related disparities may play a significant role in the clinical and laboratory characteristics of cSLE, as well as its performance in distinct classification criteria. Monogenic lupus is associated with higher disease damage scores and mortality rate compared to sporadic cSLE. Adolescent face unique challenges, with comorbid psychiatric diagnosis, low resilience and nonadherence posing relevant challenges. A recent international task force has outlined pivotal principles and points-to-consider for treat-to-target (T2T) in cSLE patients. While the past year did yield new randomized controlled trial for cSLE treatment, publications focused on broader management strategies, including the impact of ultraviolet radiation exposure, immunization, and strict blood pressure control. Additionally, case reports and series have evaluated the efficacy/safety profiles of both available and emerging treatments. Summary Current studies highlighted the various facets of cSLE, epidemiology, clinical, laboratory, classification criteria, adolescent issues, prognosis, surveillance, T2T approach and drug management. Despite notable progress, the scarcity of randomized trials emphasizes the need to delineate safer and more efficacious treatment modalities in cSLE.

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“…[1,2] Around 4% of cSLE developed advanced chronic kidney disease (CKD). [2,3] Up to 15% of patients with childhood-onset lupus nephritis (cLN) may progress to end-stage kidney disease (ESKD), [4,5] and is also associated with signi cant morbidity and mortality, compared to general paediatric population. [6] Histopathological ndings in LN are de ned according to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classi cation.…”

Section: Introductionmentioning

confidence: 99%

Renal vascular lesions in Childhood-onset Lupus Nephritis

Lin,

Chan,

Mak

et al. 2024

Preprint

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Background: This study aimed to determine the clinical significance of renal vascular lesions (RVLs) in childhood-onset lupus nephritis (cLN). Methods: We retrospectively reviewed all children with biopsy-proven cLN between 2004-2020 to evaluate the prevalence of RVLs on kidney biopsy and its associated factors and long-term outcomes. The composite renal outcome was defined as advanced chronic kidney disease (CKD) stage 3-5, end-stage kidney disease (ESKD) and death. Results: 107 biopsies from 84 Chinese patients were analysed. RVLs were observed in 19 patients (22.6%), including non-inflammatory necrotizing vasculopathy (NNV, n=6), thrombotic microangiopathy (TMA, n=4), arterial sclerosis (AS, n=3), concurrent NNV with AS (n=4), concurrent NNV with TMA (n=1) and concurrent true renal vasculitis with AS (n=1). The presence of RVLs was associated with lower estimated glomerular filtration rate (eGFR) (66.9±40.3 vs 95.6±39.4ml/min/1.73m2, p=0.005), haemoglobin level (9.1±1.9 vs 10.4±1.9g/dL, p=0.008) and platelet count (150.1±96.4 vs 217.2±104.8 x 109/L, p=0.01). LN classes and activity/chronicity indices were similar. Patients with RVLs had poorer composite renal outcomes, though not reaching statistical significance (log-rank test, p=0.06). The presence of NNV was associated with inferior survival free from composite renal outcome (log-rank test, p = 0.0018), compared to other forms of RVLs and those without RVLs. Univariate analysis revealed NNV (HR 7.08, 95% CI 1.67-30.03) was predictive of composite renal outcome. Conclusion: RVLs are present in one-fifth of cLN patients and are associated with severe presentation. NNV is associated with worse long-term renal outcome. Routine evaluation of RVLs is warranted and should be incorporated into future classification criteria.

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Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus

Cited by 9 publications

References 50 publications

Lupus Nephritis in Children: Novel Perspectives

Lupus Nephritis in Children: Novel Perspectives

Updates in the care and management of children and adolescents with systemic lupus erythematosus

Renal vascular lesions in Childhood-onset Lupus Nephritis

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