Renal relapse in children and adolescents with childhood-onset lupus nephritis: a 20-year study.

Autor:	Chan EY; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong.; Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong., Yap DY; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong.; Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong School of Clinical Medicine, Hong Kong., Wong WH; Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong., Wong SW; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Lin KY; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Hui FY; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Li JY; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Lam SS; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Wong JK; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Lai FF; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Ho TW; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Tong PC; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Lai WM; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong., Chan TM; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong.; Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong School of Clinical Medicine, Hong Kong., Ma AL; Paediatric Nephrology Centre, Hong Kong Children's Hospital, Hong Kong.; Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Apr 02; Vol. 63 (4), pp. 953-961.
DOI:	10.1093/rheumatology/kead447
Abstrakt:	Objectives: There is little data on renal relapse in childhood-onset LN (cLN). We investigate the incidence, predictive factors and outcomes related to renal relapse. Methods: We conducted a retrospective cohort study of all cLN diagnosed at ≤18 years between 2001-2021 to investigate the incidence and outcomes related to renal relapse. Results: Ninety-five Chinese cLN patients (91% proliferative LN) were included. Induction immunosuppression was prednisolone and CYC [n = 36 (38%)] or MMF [n = 33 (35%)]. Maintenance immunosuppression was prednisolone and MMF [n = 53 (54%)] or AZA [n = 29 (31%)]. The rates of complete remission/partial remission (CR/PR) at 12 months were 78.9%/7.4%. Seventy renal relapses occurred in 39 patients over a follow-up of 10.2 years (s.d. 5.9) (0.07 episode/patient-year). Relapse-free survival was 94.7, 86.0, 80.1, 71.2, 68.3, 50.3 and 44.5% at 1, 2, 3, 4, 5, 10 and 20 years, respectively. Multivariate analysis showed that LN diagnosis <13.1 years [adjusted hazard ratio (HRadj) 2.59 995% CI 1.27, 5.29), P = 0.01], AZA maintenance [HRadj 2.20 (95% CI 1.01, 4.79), P = 0.05], PR [HRadj 3.9 (95% CI 1.03, 9.19), P = 0.01] and non-remission [HRadj 3.08 (95% CI 1.35, 11.3), P = 0.04] at 12 months were predictive of renal relapse. Renal relapse was significantly associated with advanced chronic kidney disease (stages 3-5) and end-stage kidney disease (17.9% vs 1.8%, P < 0.01). Furthermore, patients with renal relapse showed an increased incidence of infections (30.8% vs 10.7%, P = 0.02), osteopenia (38.5% vs 17.9%, P = 0.04) and hypertension (30.8% vs 7.1%, P < 0.01). Conclusion: Renal relapse is common among cLN, especially among young patients, and is associated with an increased incidence of morbidity and mortality. Attaining CR and the use of MMF appear to decrease the incidence of renal relapse. (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu