Pediatric Lupus Nephritis-Review of Literature

Thakur, Neha; Rai, Narendra; Batra, Prerna

doi:10.2174/1573397112666160404124308

Cited by 9 publications

(7 citation statements)

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“…When comparing the clinical and subclinical characteristics of LN classes, we found a gradual decline in the serum albumin concentration, the proportion of patients with nephrotic syndrome together with the median uPCR and SLEDAI score gradually increased from LN class II to V with P < 0.05 (Table 4). Our results are consistent with some of the previously conducted studies and the pathogenetic mechanism of the kidney damage of LN (9,12,16,22,23).…”

Section: Lupus Nephritis (Ln) Is a Common Manifestation Among Sle Patients With A Prevalence Of 60% In Adults Andsupporting

confidence: 93%

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Association Between Hypoalbuminemia, Degree of Proteinuria, and Lupus Nephritis Class: A Single-Center Cross-sectional Biopsy Study

et al. 2021

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Background: The current study intended to determine whether serum albumin level and urine protein/creatinine rate (uPCR) are appropriate predictors of severe lupus nephritis in childhood-onset SLE. Objectives: Following a cross-sectional single-center design, 85 LN children referred to the National Children Hospital, Ha Noi, Viet Nam, from 6/2019 to 6/2020 were recruited. Renal biopsy was performed for all participants. Methods: Following a cross-sectional single-center design, 85 LN children referred to the National Children Hospital, Ha Noi, Viet Nam, from 6/2019 to 6/2020 were recruited. Renal biopsy was performed for all participants. Results: The mean SLEDAI score of all patients was 14.69. The proportion of patients with high and very high SLEDAI was 61.2 and 17.6%, respectively. The mean concentration of serum albumin was 28.55 g/L, and the proportion of decreased albumin concentration was 55.3%. The median uPCR was 446.6 mg/mmol in which 76.5% of values were ≥ 200 mg/mmol. Pathological morphology of LN class from I to VI was observed in 0%, 17.6%, 37.6 %, 37.6%, 7.1%, and 0%, respectively. Serum albumin level and uPCR presented the predictive value for severe and active LN (class IV and V); (AUC: 0.725 P < 0.001 for both). Conclusions: Serum albumin and uPCR were appropriate predictors for severe and active LN in Vietnamese children.

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Section: Lupus Nephritis (Ln) Is a Common Manifestation Among Sle Patients With A Prevalence Of 60% In Adults Andsupporting

confidence: 93%

“…SLE is a chronic inflammatory disease that affects the kidneys in about 50% of adult patients and about 80% of children (8)(9)(10). Lupus nephritis is one of the most common manifestations of SLE patients.…”

Section: Introductionmentioning

confidence: 99%

Association Between Hypoalbuminemia, Degree of Proteinuria, and Lupus Nephritis Class: A Single-Center Cross-sectional Biopsy Study

et al. 2021

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“…Class IV LN, younger age, HT, impaired renal function and low C3 levels at the time of diagnosis are reported to be indicators of poor prognosis and low treatment response in LN. 11 While corticosteroids and CYP are the mainstay of induction therapy; azathioprine, MMF, rituximab and tacrolimus are other options which are shown to be efficient. 12 Following the induction phase, all patients with LN should be administered maintenance therapy to sustain remission.…”

Section: Discussionmentioning

confidence: 99%

“…Azathioprine and MMF were shown to be superior to CYP as a maintenance drug, with less serious side effects. [11][12][13] Regarding general approach to treatment of infantile LN, our patient was treated with CYP and high dose steroids in induction phase followed by MMF and low dose steroids as maintenance therapy. Despite having severe clinical and laboratory features at presentation, he achieved remission in the third month of therapy and still in remission with good growth.…”

Section: Discussionmentioning

confidence: 99%

Infantile systemic lupus erythematous presenting as nephrotic syndrome in a 12-month-old boy: a case report

et al. 2021

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Background. Systemic lupus erythematous (SLE) is extremely rare in infants and has been reported to be a much more severe disease with higher prevalence of critical organ involvement. Herein we present the clinical and laboratory features of infantile SLE (iSLE) with an onset of nephrotic syndrome (NS) during the first year of life. Case. A 12-month-old boy was suffering from generalized edema for two months. He had thrombocytopenia, hemolytic anemia with positive direct and indirect Coombs tests and proteinuria of nephrotic-range. Other laboratory studies revealed slightly decreased C3, low C1q and normal ANA and C4 levels; anti-phospholipid and anti-cardiolipin antibodies were also found to be negative. Renal biopsy revealed Class IV lupus nephritis. The patient also suffered from massive pulmonary thromboembolism. Complete remission was achieved with steroid, cyclophosphamide, mycophenolate mofetil and anticoagulant therapy. Conclusion. iSLE should be kept in mind especially in infantile NS with multisystem involvement. Renal biopsy is mandatory for early diagnosis. Although the disease was reported to have poor prognosis, complete remission could be achieved with intensive immunosuppressive therapy.

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“…While childhood-onset lupus comprises only about 15%-20% of all lupus patients (4,5), it is di cult to perform large randomized controlled trials (RCTs) in pediatric LN given small numbers. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) has developed consensus treatment plans (CTPs) in an effort to reduce heterogeneity in treatment and better enable future comparative effectiveness studies.…”

mentioning

confidence: 99%

Differences in Rituximab Use Between Pediatric Rheumatologists and Nephrologists for the Treatment of Refractory Lupus Nephritis and Renal Flare in Childhood-Onset Sle

Gilbert

Goilav

Hsu

et al. 2021

Preprint

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Background: Consensus treatment plans have been developed for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in childhood-onset systemic lupus erythematosus. However, patients who do not respond to initial therapy, or who develop renal flare after remission, warrant escalation of treatment. Our objective was to assess current practices of pediatric nephrologists and rheumatologists in North America in treatment of refractory proliferative LN and flare.Methods: Members of Childhood Arthritis and Rheumatology Research Alliance and the American Society for Pediatric Nephrology were surveyed in November 2015 to assess therapy choices (other than modifying steroid dosing) and level of agreement between rheumatologists and nephrologists for proliferative LN patients. Two cases were presented: 1) refractory disease after induction treatment with corticosteroid and cyclophosphamide and 2) nephritis flare after initial response to treatment. Survey respondents chose treatments for three follow up scenarios for each case that varied by severity of presentation. Treatment options included cyclophosphamide, mycophenolate mofetil, rituximab, and others, alone or in combination.Results: Treatment choices between nephrologists and rheumatologists were highly variable. A majority (>50%) consensus of either nephrologists or rheumatologists on treatment choice was only achieved in two of six total follow up scenarios for refractory LN or flare. Rheumatologists in comparison to nephrologists chose more therapy options that contained rituximab in five of six scenarios. These differences were statistically significant (p < 0.05). Conclusions: Therapy choices for pediatric rheumatologists and nephrologists in the treatment of refractory LN or LN flare were highly variable with rheumatologists more often choosing rituximab. Further investigation is necessary to delineate the reasons behind this finding. This study highlights the importance of collaborative efforts in developing consensus treatment plans for pediatric LN.

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Pediatric Lupus Nephritis-Review of Literature

Cited by 9 publications

References 0 publications

Association Between Hypoalbuminemia, Degree of Proteinuria, and Lupus Nephritis Class: A Single-Center Cross-sectional Biopsy Study

Association Between Hypoalbuminemia, Degree of Proteinuria, and Lupus Nephritis Class: A Single-Center Cross-sectional Biopsy Study

Infantile systemic lupus erythematous presenting as nephrotic syndrome in a 12-month-old boy: a case report

Differences in Rituximab Use Between Pediatric Rheumatologists and Nephrologists for the Treatment of Refractory Lupus Nephritis and Renal Flare in Childhood-Onset Sle

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