Renal tubular dysfunction in children with systemic lupus erythematosus

Marks, Stephen D.; Shah, Vanita; Pilkington, Clarissa; Woo, Patricia; Dillon, Michael J.

doi:10.1007/s00467-004-1707-6

Cited by 23 publications

(10 citation statements)

References 39 publications

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“…Glucocorticoids alone or in combination with immunosuppressive agents may also be considered in cases of class I LN with podocytopathy on the electron microscopy (minimal change disease)63 64 or interstitial nephritis 65 66…”

Section: Resultsmentioning

confidence: 99%

Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis

et al. 2012

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ObjectivesTo develop recommendations for the management of adult and paediatric lupus nephritis (LN).MethodsThe available evidence was systematically reviewed using the PubMed database. A modified Delphi method was used to compile questions, elicit expert opinions and reach consensus.ResultsImmunosuppressive treatment should be guided by renal biopsy, and aiming for complete renal response (proteinuria <0.5 g/24 h with normal or near-normal renal function). Hydroxychloroquine is recommended for all patients with LN. Because of a more favourable efficacy/toxicity ratio, as initial treatment for patients with class III–IVA or A/C (±V) LN according to the International Society of Nephrology/Renal Pathology Society 2003 classification, mycophenolic acid (MPA) or low-dose intravenous cyclophosphamide (CY) in combination with glucocorticoids is recommended. In patients with adverse clinical or histological features, CY can be prescribed at higher doses, while azathioprine is an alternative for milder cases. For pure class V LN with nephrotic-range proteinuria, MPA in combination with oral glucocorticoids is recommended as initial treatment. In patients improving after initial treatment, subsequent immunosuppression with MPA or azathioprine is recommended for at least 3 years; in such cases, initial treatment with MPA should be followed by MPA. For MPA or CY failures, switching to the other agent, or to rituximab, is the suggested course of action. In anticipation of pregnancy, patients should be switched to appropriate medications without reducing the intensity of treatment. There is no evidence to suggest that management of LN should differ in children versus adults.ConclusionsRecommendations for the management of LN were developed using an evidence-based approach followed by expert consensus.

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Section: Resultsmentioning

confidence: 99%

Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis

et al. 2012

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“…Thus, we believe that individual components should be examined separately. The significance of the TI compartment in LN disease has been a topic of much interest, and, for many years, authors have suggested that examination of the TI compartment might be useful for predicting outcome in LN [6,26]. Recently, studies of urinary biomarkers in LN kidney injury suggest that biomarkers may play a role in diagnosis and risk stratification of kidney damage [24,[27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of activity, chronicity and tubulointerstitial indices for childhood lupus nephritis

et al. 2008

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Few data exist on use of the National Institutes of Health (NIH) activity index (AI) and chronicity index (CI) in childhood lupus nephritis (LN). A tubulointerstitial activity index (TIAI) has been derived but not validated. We evaluated clinicopathologic correlations of the AI, CI and TIAI in children with LN who had undergone initial renal biopsy (n=25, age 12.4+/-2.7 years, biopsy 1) and 1 year after treatment (n=15, biopsy 2). The TIAI correlated with the AI at biopsy 1 (r=0.76, P=0.001) and biopsy 2 (r=0.52, P=0.05), but not with CI scores. Mean AI and CI scores changed substantially from biopsy 1 to biopsy 2 (P<0.05), but TIAI scores did not. Higher AI and TIAI scores correlated with proteinuria at both biopsies (r=0.51-0.76, P<0.05); CI scores correlated with estimated creatinine clearance (r=0.46-0.58, P<0.05). Improved AI score from biopsy 1 to biopsy 2 was associated with decrease in proteinuria. These results suggest that the AI and CI are useful in childhood LN. The TIAI may be a valid measure to evaluate the tubulointerstitium, but research is needed to define its responsiveness to change with therapy.

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“…Most published works on RTD are on adult patients 24–27 . A prospective study in children reported RTD as an earlier marker of lupus nephritis (LN) than albuminuria 21 …”

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confidence: 99%

“…2,3,8,15,[18][19][20] Published works on the extra-glomerular disease, namely tubulointerstitial nephritis (TIN), and vascular lesions like lupus vasculopathy (LV), thrombotic microangiopathy (TMA), vasculitis and arterio-/arteriolosclerosis are few. [21][22][23] Renal tubular function (RTF) is not routinely investigated in lupus patients in spite of the fact that SLE may be associated with varieties of renal tubular dysfunction (RTD). Most published works on RTD are on adult patients.…”

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confidence: 99%