[Development of lupus nephritis in childhood]

The outcome of lupus nephritis was studied in 12 children. Their age at onset was 5-13 years (mean 9.8 +/- 2.1 years), less than that reported in recent years of children with lupus nephritis. All patients had clinical symptoms and signs and/or laboratory findings of renal involvement. Renal biopsy, performed in all patients, showed: minimal change in 3 patients, mesangial glomerulonephritis in 5, focal proliferative glomerulonephritis in 3 and membranous glomerulonephritis in one patient. There was no correlation between age at onset and histological categories, while clinical data were well correlated with the degree of histological involvement. 11 patients were followed for 5.16 +/- 3.2 years (range 1-13 years); 7 patients are in complete remission, 3 patients have only microscopic hematuria and/or mild proteinuria, one patient died because of infection complicating pulmonary involvement. Our report confirms a more favorable evolution of lupus nephritis in children than in adults. In particular none of our patients whose disease started before the age of 10 years had poor outcome, in contrast to previous report describing a higher mortality and morbidity in younger children. The more favorable prognosis of our patients could depend not only on the absence of the more severe form of lupus nephritis that is diffuse proliferative glomerulonephritis, but also on the earlier diagnosis and subsequent therapy.