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[Lupus nephritis in children]
D Zwolińska1, K Kiliś-Pstrusińska, I Wikiera
1Katedry i Kliniki Nefrologii Pediatrycznej AM we Wrocławiu.
Insights
Lupus nephritis predominantly affects young girls, highlighting the need for early renal biopsy and tailored treatments. Children with Class IV lupus nephritis face a poor prognosis, emphasizing the importance of timely intervention.
Area of Science:
- Pediatric Nephrology
- Rheumatology
- Immunology
Context:
- Systemic lupus erythematosus (SLE) is a complex autoimmune disease with significant renal involvement.
- Lupus nephritis affects 65-70% of SLE patients clinically and 80-100% morphologically.
- Pediatric lupus nephritis presents unique challenges in diagnosis and management.
Purpose:
- To analyze the clinical course, treatment, and outcomes of lupus nephritis in pediatric patients.
- To identify factors influencing prognosis in children with lupus nephritis.
- To evaluate the role of early renal biopsy in guiding treatment strategies.
Summary:
- This study reviewed 15 pediatric cases of lupus nephritis (1989-1998), analyzing clinical data, biopsy results (Class II-V), and treatment regimens (steroids, cyclophosphamide, Sandimmune).
- Outcomes included remission in 11 children, renal insufficiency in 2, and mortality in 2.
- Lupus nephritis is most common in girls aged 12-15, with Class IV nephritis, anemia, low complement, and active urinary sediment indicating a poor prognosis.
Impact:
- Early renal biopsy and individualized treatment are crucial for managing pediatric lupus nephritis.
- Identifying high-risk patients, particularly those with Class IV disease, allows for targeted interventions.
- Findings underscore the need for prompt diagnosis and aggressive management to improve outcomes in children with lupus nephritis.
Unlabelled:
Systemic lupus erythematosus is a very variable and pleomorphic disease. Lupus nephritis with clinical manifestation appears in 65-70% of patients, kidney morphological changes are observed in 80-100%. In this study we analysed clinical course of lupus nephritis in 15 children treated between 1989-1998 (10 girls, 5 boys, aged 9.5-16 years). The following data were considered: inherited susceptibility to the disease, the first symptoms, primary diagnosis, the symptoms at admission to clinical hospital, the time from first symptoms to diagnosis of lupus, laboratory results, clinical course, treatment, outcome of disease. All children underwent percutaneous renal biopsy. 2 patients had class II, 7 patients--class III, 5--class IV and 1 class V of lupus nephritis. In the treatment were used: oral prednisone, intravenous methylprednisolone, methylprednisolone pulse, cyclophosphamide (oral and i.v.), sandimmum. Total or partial remission with normal renal function was observed in 11 children, 1 had stable renal insufficiency, 1 with terminal renal insufficiency started regular HD treatment, 2 patients died.
Conclusions:
Lupus nephritis appears the main in young girls aged 12-15 years; the children with renal symptoms need of early renal biopsy and individual treatment; the prognosis of children with IV class lupus nephritis, severe anaemia, low complement, active urinary sediment and quick progress of renal insufficiency is poor.