Retrospective analysis of the renal outcome of pediatric lupus nephritis

Abstract

The aim of this study was to analyze the renal outcome of pediatric lupus nephritis in the past two decades. We retrospectively reviewed the medical records of patients who fulfilled the 1987 American Rheumatism Association revised criteria for systemic lupus erythematosus who were followed up at the National Taiwan University Hospital between 1980 and 2001. All new patients who were under 18 years of age at the time of diagnosis were enrolled and were followed up until death, loss to follow-up, or till the end of 2002. The response to the treatment and renal outcome were analyzed. Seventy-two children (64 girls and 8 boys) were enrolled in the study. The mean age at diagnosis was 13.93+/-0.35 years (mean +/- SEM). The mean duration of follow-up was 7.12+/-0.51 years. The 5-year renal survival rate (survival without dialysis or transplantation) was 63.13% and the 10-year survival rate was 53.54%. It was significantly better in patients receiving cyclophosphamide (CYC) pulse therapy. The 5-year survival rate for these patients was 87.82% and the 10-year survival rate was 81.06%. The renal survival curve was better in the CYC pulse therapy group than in the no CYC pulse therapy group, with p=0.0022. The duration between the diagnosis of lupus nephritis and end-stage renal disease (ESRD) was significantly longer in the CYC group (9.66+/-1.32 yrs) than in the no CYC group (3.24+/-0.94 yers), p=0.036. In the multivariate analysis, risk factors of developing ESRD were failure to achieve complete remission, higher serum creatinine at the initiation of treatment, and not receiving CYC pulse therapy. The renal survival was significantly better in the CYC pulse therapy group. The CYC pulse therapy was recommended in pediatric lupus nephritis patients and every effort should be made to achieve complete remission.

Short-term outcomes of severe lupus nephritis in a cohort of predominantly African–American children

“…This suggests that the higher incidence of hypertension among our patients might be due to a difference in our patient selection criteria. Otherwise, the incidence of proteinuria, macroscopic hematuria and the distributions of the WHO classes in our patients were very similar to those of most other studies [14,17,18].…”

“…Although the data suggested that we had a higher percentage of hypertensive patients than in most other pediatric studies [13,14,17], these studies included patients with class II lupus nephritis, which made comparison with our study very difficult. However, another recent study from Taiwan that included only patients with severe lupus nephritis reported an incidence of 54% hypertensive patients before treatment [18]. This suggests that the higher incidence of hypertension among our patients might be due to a difference in our patient selection criteria.…”

“…Previous studies have shown that patients with childhood onset have more severe disease at presentation and worse outcomes [2][3][4]. Since nephritis is the major determinant of the outcome in SLE [5,6], outcomes in children with severe lupus nephritis have been studied and reported by many groups over the past two decades [7][8][9][10][11][12][13][14][15][16][17][18][19]. Owing to substantial improvements in the management and care of patients with severe lupus nephritis, the outcomes of these patients have improved.…”

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

“…Among the additional 26 patients without renal biopsies, four died within the same observation period. Both the patient and renal survival rates among our study cohort were similar to or better than those reported in several other pediatric series during the past decade [5,22,23,26,28,29,33]. Contrary to expectation, neither renal histology, including the WHO classification and the activity and chronicity indices, nor any other sign or symptom was independently correlated with the outcome.…”

“…Based on the results of this retrospective study, patient and renal survival rates among Iranian children with biopsyproven LN are high at the mid-term follow-up compared to those reported for other countries [19][20][21][22][23].…”