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Clinical outcomes of childhood lupus nephritis: a single center’s experience

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Abstract

This study retrospectively reviewed the medical records of children with lupus nephritis (LN) who were treated at Seoul National University Children’s Hospital from 1986 to 2005 (mean duration 8.3±4.4 years). The records of 77 children (22 male and 55 female) were examined. The mean age at diagnosis was 11.9±3.0 years. The initial biopsy results revealed a WHO class IV classification for 60 (88.2%) of 68 biopsy proven cases. Of 77 patients, 67 (87.0%) responded initially to the high-dose corticosteroids with or without additional immunosuppressive therapy. Of the initial responders (67), 30 (44.8%) experienced at least one episode of proteinuric (24) or nephritic (6) flare. Thirteen patients (16.9%) progressed to either chronic renal failure (CRF) or end-stage renal disease (ESRD). Six (7.8%) patients died. A Kaplan–Meier estimate of patient survival and CRF-free survival rate was 95.4% and 88.7% at 5 years and 91.8% and 74.7% at 10 years, respectively. Multivariate analysis for class IV LN revealed male gender (P=0.029), initial hypertension (P=0.001) and absence of remission (P=0.002) to be prognostic factors predicting CRF. Glomerulosclerosis of 10% or more (P=0.005), nephritic flare (P=0.011), and presence of anti-phospholipid antibody (P=0.017) or syndrome (P=0.004) were also found to be independent risk factors for CRF. Cyclophosphamide pulse therapy failed to demonstrate superiority over other combined immunosuppressants used for the treatment of diffuse proliferative LN.

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Authors and Affiliations

  1. Department of Pediatrics, Seoul National University Children’s Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea

    Byong Sop Lee, Hee Yeon Cho, Eo Jin Kim, Hee Gyung Kang, Il Soo Ha, Hae Il Cheong, Joong Gon Kim & Yong Choi

  2. Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea

    Hyun Soon Lee

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  1. Byong Sop Lee
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Lee, B.S., Cho, H.Y., Kim, E.J. et al. Clinical outcomes of childhood lupus nephritis: a single center’s experience. Pediatr Nephrol 22, 222–231 (2007). https://doi.org/10.1007/s00467-006-0286-0

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