Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus.
Autor: | Sakamoto AP; Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil. anapaula_skmt@yahoo.com., Silva CA; Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil., Islabão AG; Pediatric Rheumatology Unit, Hospital da Crianca de Brasilia Jose Alencar, Brasilia, DF, Brazil., Novak GV; Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil., Molinari B; Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil., Nogueira PK; Pediatric Nephrology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil., Pereira RMR; Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Saad-Magalhães C; Pediatric Rheumatology Division, Sao Paulo State University (UNESP)-Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil., Clemente G; Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil., Piotto DP; Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil., Aikawa NE; Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Pitta AC; Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil., Trindade VC; Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil., Appenzeller S; Department of Orthopedics, Rheumatology and Traumatology-School of Medical Science-University of Campinas (UNICAMP), SP, Campinas, Brazil., Carvalho LM; Pediatric Rheumatology Unit, Ribeirao Preto Medical School-University of Sao Paulo, Ribeirao Preto, SP, Brazil., Rabelo-Junior CN; Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil., Fonseca AR; Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, RJ, Brazil., Sztajnbok FR; Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, RJ, Brazil., Santos MC; Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, SP, Brazil., Bica BE; Rheumatology Division, Universidade Federal do Rio de Janeiro, Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ, Brazil., Sena EG; Pediatric Rheumatology Unit, Lauro Wanderley University Hospital, Universidade Federal da Paraiba, Joao Pessoa, PB, Brazil., Moraes AJ; Pediatric Rheumatology Unit, Federal University of Para, Belem, PA, Brazil., Fraga MM; Pediatric Rheumatology Unit, Hospital Infantil Darcy Vargas, Sao Paulo, SP, Brazil., Robazzi TC; Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, BA, Brazil., Spelling PF; Pediatric Rheumatology Unit, Hospital Evangelico de Curitiba, Curitiba, PR, Brazil., Scheibel IM; Pediatric Rheumatology Unit, Hospital Crianca Conceicao, Porto Alegre, RS, Brazil., Cavalcanti AS; Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, PE, Brazil., Matos EN; Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil., Guimarães LJ; Pediatric Rheumatology Unit, University of Brasilia, Brasilia, DF, Brazil., Santos FP; Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil., Mota LMH; Rheumatology Unit, University of Brasilia, Brasilia, Brazil., Bonfá E; Division of Rheumatology Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Terreri MT; Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil. |
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Jazyk: | angličtina |
Zdroj: | Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2023 Jun; Vol. 38 (6), pp. 1843-1854. Date of Electronic Publication: 2022 Nov 21. |
DOI: | 10.1007/s00467-022-05811-y |
Abstrakt: | Background: Lupus nephritis (LN) is a frequent manifestation of childhood-onset systemic lupus erythematosus (cSLE) with a potential risk for kidney failure and poor outcomes. This study aimed to evaluate stages III, IV, and V of chronic kidney disease (CKD) and investigate risk factors for CKD in cSLE patients. Methods: We performed a nationwide observational cohort study in 27 pediatric rheumatology centers, including medical charts of 1528 cSLE patients. Data were collected at cSLE diagnosis, during follow-up, and at last visit or death, between September 2016 and May 2019. Results: Of 1077 patients with LN, 59 (5.4%) presented with CKD, 36/59 (61%) needed dialysis, and 7/59 (11.8%) were submitted for kidney transplantation. After Bonferroni's correction for multiple comparisons (p < 0.0013), determinants associated with CKD were higher age at last visit, urinary biomarker abnormalities, neuropsychiatric involvement, higher scores of disease activity at last visit and damage index, and more frequent use of methylprednisolone, cyclosporine, cyclophosphamide, and rituximab. In the regression model analysis, arterial hypertension (HR = 15.42, 95% CI = 6.12-38.83, p ≤ 0.001) and biopsy-proven proliferative nephritis (HR = 2.83, 95%CI = 1.70-4.72, p ≤ 0.001) increased the risk of CKD, while children using antimalarials had 71.0% lower CKD risk ((1.00-0.29) × 100%) than children not using them. The Kaplan-Meier comparison showed lower survival in cSLE patients with biopsy-proven proliferative nephritis (p = 0.02) and CKD (p ≤ 0.001). Conclusions: A small number of patients manifested CKD; however, frequencies of dialysis and kidney transplantation were relevant. This study reveals that patients with cSLE with hypertension, proliferative nephritis, and absence of use of antimalarials exhibited higher hazard rates of progression to CKD. A higher resolution version of the Graphical abstract is available as Supplementary information. (© 2022. The Author(s), under exclusive licence to International Pediatric Nephrology Association.) |
Databáze: | MEDLINE |
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