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Lupus Nephritis in Indian Children: Flares and Refractory Illness
Jaiben George1, Kesavan P Sankaramangalam2, Aditi Sinha2
1Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Jaiben George, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029, India. jaibengeorge@gmail.com.
Insights
Pediatric lupus nephritis patients experiencing multiple renal flares or treatment resistance had poorer long-term kidney survival. Aggressive management of flares is crucial for preventing end-stage renal disease in childhood lupus nephritis.
Area of Science:
- Pediatric Nephrology
- Autoimmune Diseases
- Clinical Research
Background:
- Lupus nephritis is a severe manifestation of childhood systemic lupus erythematosus.
- Understanding factors influencing renal outcomes is critical for effective management.
Purpose of the Study:
- To determine the incidence of renal flares and treatment resistance in pediatric lupus nephritis.
- To assess the association of flares and resistance with long-term renal survival.
Main Methods:
- Retrospective review of 34 children with lupus nephritis (Class II-IV).
- Minimum five-year follow-up for treatment response, flares, and renal survival.
- Regression analyses to identify factors associated with refractoriness, flares, and survival.
Main Results:
- Flares occurred at an incidence of 0.16 episodes/person/year.
- 23.5% of patients were refractory to treatment.
- Five-year renal survival was 79%, with multiple flares and treatment refractoriness linked to poor outcomes.
Conclusions:
- Multiple renal flares and treatment refractoriness are significant predictors of poor renal survival in pediatric lupus nephritis.
- Aggressive management and prevention of renal flares are essential to prevent progression to end-stage renal disease.
Objective:
To evaluate the incidence of flares and treatment resistance in children with lupus nephritis and their association with renal outcomes.
Methods:
We retrospectively reviewed the case records of 34 children treated for lupus nephritis (Class II-IV) at a single center. Patients were followed for a minimum of five years to evaluate treatment response, onset of flares, and renal survival. Regression analyses were performed to identify the factors associated with treatment refractoriness, incidence of flares and renal survival.
Results:
The incidence of flares was 0.16 episodes/person/year. Eight patients (23.5%) were refractory to treatment. The five-year renal survival was 79%. Multiple episodes of flares (P=0.028) and therapy refractoriness (P=0.003) were associated with poor renal survival.
Conclusions:
Prevention and aggressive management of renal flares is expected to prevent progression to end stage renal disease in lupus nephritis.
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