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Lupus nephritis in children
1Division of Nephrology and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Childhood lupus nephritis, a kidney complication of systemic lupus erythematosus, is more common in children than adults. Effective treatments improve survival, but long-term management requires careful attention to minimize therapy-related complications.
Area of Science:
- Pediatric Nephrology
- Rheumatology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) frequently affects the kidneys in children, presenting a spectrum of renal involvement.
- Childhood lupus nephritis occurs more commonly than in adults and can range from mild urinalysis abnormalities to severe kidney failure.
- Significant advancements in treatment have improved survival rates for children with lupus nephritis over the past three decades.
Purpose of the Study:
- To review the current understanding of childhood lupus nephritis, including its clinical manifestations, treatment strategies, and long-term outcomes.
- To highlight the effectiveness of available therapies and the challenges associated with managing this condition in pediatric patients.
- To emphasize the importance of meticulous, long-term patient care to optimize outcomes and mitigate treatment-related morbidities.
Main Methods:
- Review of current literature and clinical guidelines on childhood lupus nephritis.
- Analysis of treatment protocols, including corticosteroids, cytotoxic agents, and cyclosporine.
- Discussion of the impact of therapy on patient survival, morbidity, and psychosocial development.
Main Results:
- Corticosteroid therapy is the primary treatment for childhood lupus nephritis.
- Combination therapy with cytotoxic agents alongside corticosteroids enhances both short-term and long-term prognoses.
- While survival has improved, complications such as opportunistic infections, growth disturbances, and psychosocial issues remain significant challenges.
Conclusions:
- Effective treatments for childhood lupus nephritis have significantly improved patient survival.
- Long-term management requires a comprehensive approach to address both the disease activity and the adverse effects of immunosuppressive therapies.
- Optimizing patient outcomes necessitates vigilant, multidisciplinary care over extended periods to manage chronic illness and treatment complications.
Abstract:
The renal manifestations of systemic lupus erythematosus in childhood range from minor abnormalities detected on urinalysis to severe renal insufficiency requiring renal replacement therapy. Clinically significant renal involvement in systemic lupus erythematosus is more common in children than in adults. Effective treatment for childhood lupus nephritis is available, and the prognosis for affected children has improved over the course of the last 30 years. Corticosteroid therapy remains the cornerstone of treatment for children with lupus nephritis. The addition of cytotoxic agents to corticosteroid treatment improves both the long and short-term prognoses. Cyclosporin may improve the clinical manifestations of lupus nephritis although the disease remains active serologically. Although survival in childhood lupus has improved, complications of therapy result in significant morbidity with distressing frequency. Immunosuppression may result in mortality and morbidity due to opportunistic infections. Individuals with otherwise successful control of renal manifestations of systemic lupus erythematosus may still be left with significant morbidity due to disturbances in growth due to long-term corticosteroid treatment. Psychosocial development may be adversely affected both as a result of chronic illness as well as due to the effects of therapy. Meticulous attention to detail over decades of treatment is necessary to optimize patient outcome in childhood lupus nephritis.