Clinical presentation and outcomes of childhood-onset membranous lupus nephritis.

Autor: Pereira M; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.; Division of Allergy, Immunology and Rheumatology, Texas Children's Hospital, Houston, TX, USA., Muscal E; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.; Division of Allergy, Immunology and Rheumatology, Texas Children's Hospital, Houston, TX, USA., Eldin K; Department of Pathology and Immunology, Baylor College of Medicine-Texas Children's Hospital, Houston, TX, USA., Hicks MJ; Department of Pathology and Immunology, Baylor College of Medicine-Texas Children's Hospital, Houston, TX, USA., Sagcal-Gironella ACP; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.; Division of Allergy, Immunology and Rheumatology, Texas Children's Hospital, Houston, TX, USA., DeGuzman M; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.; Division of Allergy, Immunology and Rheumatology, Texas Children's Hospital, Houston, TX, USA., Wenderfer SE; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. wenderfe@bcm.edu.; Renal Service, Texas Children's Hospital, Houston, TX, USA. wenderfe@bcm.edu.
Jazyk: angličtina
Zdroj: Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2017 Dec; Vol. 32 (12), pp. 2283-2291. Date of Electronic Publication: 2017 Jul 17.
DOI: 10.1007/s00467-017-3743-z
Abstrakt: Background: Best practices for managing childhood-onset membranous lupus nephritis (MLN) are not yet established. Most studies involve primarily or exclusively adult cohorts or pediatric cohorts with combinations of pure or mixed membranous and proliferative nephritis.
Methods: We performed a single-center cohort study of consecutively diagnosed children with pure MLN from 1990 and 2016. Patients received care in Houston, Texas, one of the most diverse metropolitan areas in North America. Renal outcomes were obtained using consensus definitions from the Childhood Arthritis and Rheumatology Research Alliance (CARRA). Logistic regression was used to detect predictors of complete renal response.
Results: A total of 56 children with MLN were identified (82% females, 44% black, 35% Hispanic) with a median follow-up time of 4.1 years. The mean age of MLN onset was 13.7 ± 3.4 years. On initial presentation 69% had nephrotic syndrome and 11% had acute kidney injury. Glucocorticoids were prescribed in 96% of patients and anti-malarials in 88%. Mycophenolate mofetil was the most common non-steroid immunosuppressive agent (69%), followed by rituximab (25%), cyclophosphamide (18%), and azathioprine (9%). Renin-angiotensin aldosterone system blocking agents were prescribed in 78% of patients. Of 37 patients with ≥2 years of follow-up, 74% achieved complete renal response at 24 months. No predictor variable of complete renal response was identified in this small cohort. Renal flares occurred in 48% of patients (86% proteinuric, 14% nephritic). On subsequent renal biopsy, 13% patients had developed proliferative nephritis.
Conclusions: This single-center cohort of childhood-onset MLN showed favorable outcomes. Utilizing pediatric renal outcomes definitions, we found that response rates were high, as were rates of renal flare.
Databáze: MEDLINE
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