Predictors of kidney disease in a cohort of pediatric patients with lupus

Abstract

Introduction Children with systemic lupus erythematosus (SLE) have an increased prevalence of kidney disease compared to their adult counterparts. Our goal was to identify potential clinical and laboratory predictors of renal disease. Methods We performed a cohort study of incident and prevalent patients with SLE aged ≤ 19 years. Retrospective data from initial presentation until study enrollment was also collected. Laboratory and clinic data were recorded from each clinic visit including disease activity indices, autoantibodies, urinalyses, blood counts, and metabolic profile. Kidney disease was defined as the presence of abnormal renal biopsy or by American College of Rheumatology case definition for lupus nephritis. Logistic regression analyses were used to determine the association between clinical and laboratory data with kidney disease in those who had renal involvement within 30 days of SLE diagnosis. We also performed a time to event analysis to identify antecedents of renal disease. Results 47 children and adolescents with SLE were followed in the cohort, 91% female and 68% Black. All of the males in the cohort developed renal disease, and all within one month of the diagnosis of SLE. In logistic regression, low serum albumin (Odds Ratio: 4.8, 95% CI: 1.9–12.5) and positive dsDNA antibodies (OR: 3.2, 95% CI: 1.7–5.9) were associated with kidney disease. In longitudinal analyses, isolated sterile pyuria (Hazard Ratio (HR): 3, 95% CI: 1.1–6.4) and low serum albumin (HR: 3.4, 95% CI: 1.7–6.9) were predictors of future kidney disease. The presence of antibodies against Ro were protective against renal disease (HR: 0.2, 95% CI: 0.05–0.5). Conclusion We identified variables associated with kidney disease, both at initial diagnosis of SLE and in longitudinal follow-up in a cohort of children with SLE. The recognition of these abnormal laboratory values may help clinicians identify patients at risk for kidney disease before its onset thus preventing long-term complications.

Long-term renal outcomes of childhood-onset global and segmental diffuse proliferative lupus nephritis

“…Immune complex deposit-induced glomerular inflammation is a typical, wellrecognized pathogenesis, but may not be the sole mechanism [26]. In our study, both subclasses demonstrated a similar extent of peripheral capillary immune aggregates, as evidenced by the degree of hyaline deposits under light microscopy examination and the intensity of immunofluorescence staining in the capillary loop.…”

Interleukin-35 as a New Biomarker of Renal Involvement in Lupus Nephritis Patients

“…The recent study by Hu et al (2017) in China showed that IL-35 pretreatment could efficiently prevent lipopolysaccharide (LPS)-induced AKI via inhibiting nuclear factor kappa B (NF-κB) activation and reducing pro-inflammatory cytokine production. In addition, previous investigators have elucidated that changes in serum complement and anti-dsDNA levels are associated with the degree of kidney damage in LN patients (Sule et al 2015). The correlations of IL-35 with anti-dsDNA and C3 have been described in the above paragraph.…”

“…In this study, we focused on exploring the correlation between IL-35 and disease activity in all SLE subjects as defined by SLEDAI-2k, anti-dsDNA, ESR, and C3 (Sule et al 2015). We showed distinctly A.…”

“…To further elucidate the potential role of IL-35 in renal involvement, we next investigated the correlation between IL-35 and clinical parameters of renal involvement, which included eGFR (Schetz et al 2014), and levels of 24-h proteinuria, BUN, Scr, BUA (Stamenkovic et al 1986), RBP (Aggarwal et al 2017), CysC (Silva et al 2011), ALB (Sule et al 2015), urinary erythrocytes and urinary leukocytes (Rahman et al 2001) in LN patients. In such a pilot study, we observed that LN patients had significantly lower eGFR and strikingly higher levels of BUN, Scr, BUA, RBP and CysC than SLE patients without nephritis.…”

Ab0491 the Performance of a Renal Activity Index in Lupus Nephritis in Induction Therapy

“…The renal activity index in lupus (RAIL) was developed using 6 urinary biomarkers to reflect disease activity. In children this tool was 92% accurate in identifying active LN 3 . Objectives: We aim to study the changes in this score in relation to induction treatment in LN.…”