Outcome of lupus nephritis in Iranian children: prognostic significance of certain features

Abstract

The objective of this study was to determine the clinical and histopathological features and outcome of children with lupus nephritis (LN). Of 84 children with systemic lupus erythematosus (SLE), we retrospectively studied 58 children (69%) under 15 years of age with biopsy-proven LN who had been followed between October 1989 and January 2005. The mean age at diagnosis or initial referral was 10.6±2.25 years, and the mean followup was 5.3±4.1 years. Class IV LN was observed in 34 (58.6%) patients. The 5-year patient and renal survival rates were 82.5 and 78.5%, respectively, in the total group, and 75 and 85.8%, respectively, in patients with Class IV LN. No independent predictor of unfavorable outcome, including renal histology, was detected by multivariate analysis. The mid-term patient and the renal survival rates of Iranian children with biopsy-proven LN are high. Within 5 years of follow-up, renal histology was not a predictor for survival.

Predictors of mortality in children with lupus nephritis

“…Early diagnosis, better treatment protocols and aggressive management of infections all contribute to the improved outcomes in this severe disease. 10,15,16 Our study confirmed previous reports that elevated creatinine levels prior to the time at diagnosis increased the risk of death. The estimation of prognosis may be enhanced by considering additional features that indicate the reversibility of the renal dysfunction, including the duration of nephritis, the rate of change of serum creatinine, and the renal histology.…”

“…In our study the mean age and gender distribution was similar to other studies. 7,[10][11][12][13] In contrast to previous reports, we found no statistically significant association in male gender, or onset of disease before puberty (12 years of age) with increased risk of patient survival. This lack of association might be related to recent improvements in accessability to health care in our patient population, differences in our referral patterns from those of other institutions, or to other as yet unrecognized factors.…”

International validation of a urinary biomarker panel for identification of active lupus nephritis in children

“…LN is characterised by a relapsing and remitting course, requiring close surveillance and prompt treatment to prevent renal damage. Worldwide, the 5-year renal survival rate in children with LN has been shown to vary between 44 and 94 % [10–13]. …”

Європейські Доказові Рекомендації По Діагностиці Та Лікуванню Люпус-Нефриту У Дітей: Ініціатива SHARE

“…It is acknowledged that renal biopsy is not always possible, for instance due to the patient's critical clinical condition or due to lack of resources to safely perform the procedure. Nephrotic syndrome, hypertension and impaired renal function are all correlated with class III/IV LN (26)(27)(28). In cases when a renal biopsy cannot be performed, these symptoms should be considered as reflecting class III/IV LN and treated likewise.…”

“…Class III or IV LN, also known as proliferative LN, are the most common and severe forms of LN in cSLE (6,26,27,(39)(40)(41). Combination of class III or IV LN with class V LN is prevalent.…”