Clinical manifestations, prognosis, and treat-to-target assessment of pediatric lupus nephritis
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Published:2021-08-11
Issue:2
Volume:37
Page:367-376
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ISSN:0931-041X
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Container-title:Pediatric Nephrology
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language:en
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Short-container-title:Pediatr Nephrol
Author:
Qiu Shiyuan, Zhang Hengci, Yu Sijie, Yang Qin, Zhang Gaofu, Yang Haiping, Li Qiu, Wang MoORCID
Abstract
Abstract
Background
Pediatric lupus nephritis (pLN) is one of the most refractory secondary kidney diseases in childhood. The treat-to-target (T2T) strategy has become the standard treatment for systemic lupus erythematosus (SLE). This study reviewed clinical features, overall remission status, and factors affecting prognosis, to guide pLN management according to T2T strategy.
Methods
This single-center retrospective study studied 220 children diagnosed with LN from January 2012 to December 2018, with > 6-month follow-up data on 173 and complete data on 137 patients. Primary outcome was treatment failure (deterioration or no response) at the latest follow-up.
Results
The most common pLN manifestation was proteinuria (81.36%). Females presented more often with rash (P<0.001) and alopecia (P=0.026) than males. Class IV LN (33.33%) was the most common grade on kidney biopsy. Median follow-up was 27.20 months (IQR, 15.78–44.45 months). One-, 3-, and 5-year cumulative overall survival rates were 93.5%, 87.8%, and 86.5%, respectively. The 5-year cumulative kidney survival rate was 97.1%. Regarding initial therapy, efficacy of corticosteroids combined with immunosuppressive agents was significantly better than corticosteroids alone (P=0.010). Factors with P<0.05 in univariate analysis, including hypoalbuminemia, higher SCr at diagnosis, lower eGFR at diagnosis, anti-dsDNA positivity, heavy proteinuria, hypertension, nervous-system involvement, treatment non-compliance, and SLEDAI-2K score, were used for logistic regression analysis. Logistic regression analysis showed hypertension (OR=0.845, P=0.011), nervous-system involvement (OR=4.240, P=0.005), treatment non-compliance (OR=6.433, P=0.001), and lower estimated glomerular filtration rate at diagnosis (OR=1.020, P=0.021) affected prognosis. At end of follow-up, 34.31% achieved varying levels of remission, and 8.76% were in low disease activity state (LDAS).
Conclusions
pLN usually presented with proteinuria, and class IV LN was the dominant pathology. Hypertension, nervous-system involvement, treatment non-compliance, and lower eGFR at diagnosis were independent risk factors for poor prognosis of kidney outcomes. Compared with renal remission rate and cumulative overall survival rate, the proportion of targets achieved was not ideal, suggesting T2T strategy should be used to guide pLN management.
Graphical abstract
Funder
Chongqing Science and Technology Development Foundation
Publisher
Springer Science and Business Media LLC
Subject
Nephrology,Pediatrics, Perinatology and Child Health
Reference25 articles.
1. Kamphuis S, Silverman E (2010) Prevalence and burden of pediatric-onset systemic lupus erythematosus. Nat Rev Rheumatol 6:538–546. https://doi.org/10.1038/nrrheum.2010.121 2. Aggarwal A, Srivastava P (2014) Childhood onset systemic lupus erythematosus: how is it different from adult SLE? Int J Rheum Dis 18:182–191 3. Wu XY, Yang M, Xie YS, Xiao WG, Lin J, Zhou B, Guan X, Luo CN, Che N, Liu XZ, Wang C, Teng JL, Cheng XB, Ye JN, Su YT, Shi H, Yin YF, Liu MR, Sun Y, Hu QY, Zhou ZC, Chi HH, Liu Y, Zhang X, Chen JW, Zhang MJ, Zhao DB, Yang CD, Wu LJ, Liu HL (2019) Causes of death in hospitalized patients with systemic lupus erythematosus: a 10-year multicenter nationwide Chinese cohort. Clin Rheumatol 38:107–115. https://doi.org/10.1007/s10067-018-4259-z 4. van Vollenhoven R, Mosca M, Bertsias G, Isenberg D, Kuhn A, Lerstrom K, Aringer M, Bootsma H, Boumpas D, Bruce IN, Cervera R, Clarke A, Costedoat-Chalumeau N, Czirjak L, Derksen R, Dorner T, Gordon C, Graninger W, Houssiau F, Inanc M, Jacobsen S, Jayne D, Jedryka-Goral A, Levitsky A, Levy R, Mariette X, Morand E, Navarra S, Neumann I, Rahman A, Rovensky J, Smolen J, Vasconcelos C, Voskuyl A, Voss A, Zakharova H, Zoma A, Schneider M (2014) Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis 73:958–967. https://doi.org/10.1136/annrheumdis-2013-205139 5. Tsang ASMW, Bultink IE, Heslinga M, Voskuyl AE (2017) Both prolonged remission and lupus low disease activity state are associated with reduced damage accrual in systemic lupus erythematosus. Rheumatology (Oxford) 56:121–128. https://doi.org/10.1093/rheumatology/kew377
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