Investigators have identified predictors of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in children with lupus nephritis, according to a presentation at the 61st ERA Congress in Stockholm, Sweden.
In a study of 73 pediatric patients, younger age at lupus nephritis onset, lower estimated glomerular filtration rate (eGFR), and neurologic manifestations at the time of kidney biopsy significantly predicted the development of stage 3-5 CKD and ESKD in univariable analyses, Ludovica Odone, MD, of Meyer Children’s University Hospital IRCCS of Firenze, Italy, and colleagues reported.
Most children who progressed to ESKD did so within the first 10 years. Over a median 13.3 years, 10 patients (13.7%) progressed to ESKD, 9 (12%) within 10 years.
Aggressive disease was evident at the time of kidney biopsy in a subset of patients: 27 displayed an eGFR less than 60 mL/min/1.73m2 and 2 children already required hemodialysis. More than half of the children (59%) had nephrotic range proteinuria.
The median proteinuria at baseline was 4 g/24 h. The median eGFR at baseline was 70 mL/min/1.73 m2. The median age of the cohort was 14 years.
At last follow-up, half of the patients had an eGFR less than 90 mL/min/1.73 m2.
Other clinical factors at kidney biopsy such as C3 and C4 levels, SLEDAI scores, lupus nephritis class, hypertension and blood, muscle, and skin involvement did not appear predictive.
References:
Odone L, Peyronel F, Calatroni M, et al. Long-term renal outcome in childhood-onset lupus nephritis. Presented at the 61st ERA Congress, May 23-25, Stockholm, Sweden. Abstract 896.
