The best predictors of poor renal outcomes in pediatric patients with lupus nephritis (LN) include male gender, requiring dialysis at the time of diagnosis, and failure to achieve remission within 1 year after induction treatment, according to new study findings.
The study included 53 patients with childhood-onset systemic lupus erythematosus: 32 who were concurrently diagnosed with LN (median age 12.1 years) and 21 who later developed LN (median age 13.8 years). Patients with a concurrent LN diagnosis were significantly more likely to have arthritis (62.5% vs 33.3%) and a lower estimated glomerular filtration rate (eGFR; 110 vs 147 mL/min/1.73 m2) compared with patients who later developed LN. Renal biopsy results showed that 54.7% of patients with LN had class 4 and 22.6% had class 3 disease.
Among treated patients, 77.3% and 73% achieved complete or partial remission at 6 and 12 months, respectively, Rezan Topaloğlu, MD, PhD, of Hacettepe University in Ankara, Turkey, reported in Nephrology Dialysis Transplantation. Patients who attained complete response at 6 months after induction treatment had better renal survival than patients who did not respond to treatment. The risk for poor renal outcome, defined as GFR less than 60 mL/min/1.73 m2 or dialysis), was a significant 8.6- and 13.8-fold higher for patients who did not attain remission at 6 and 12 months, respectively.
In addition, male vs female gender was significantly associated with an 8.4-fold increased risk for poor renal outcomes. Requiring dialysis at the time of LN diagnosis was significantly associated with a 6.5-fold increased risk.
The remission rate at 6 months was significantly higher among patients treated with mycophenolate mofetil (MMF) or cyclophosphamide (CYC) compared with other combination therapies, the investigators reported. They observed no significant difference between the CYC and MMF groups’ response rates, although 79% of class 4 patients received CYC as induction therapy. By 12 months, response rates were comparable across treatment groups.
Overall, 9.4% experienced at least 1 renal flare during the first year. Renal survival rates at 5 and 10 years were 92% and 85.7%, respectively. In the proliferative LN group, renal survival rates were 90.5% and 75%, respectively.
According to Dr Topaloğlu’s team, “prompt recognition and aggressive management of pediatric LN is essential to achieve and maintain remission.”
Demir S, Gülhan B, Özen S, et al. Long-term renal survival of pediatric patients with lupus nephritis. Nephrol Dial Transplant. Published online April 7, 2021. doi:10.1093/ndt/gfab152