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Longterm Followup of Childhood Lupus Nephritis
STEFAN HAGELBERG, YUNA LEE, JOANNE BARGMAN, GORDON MAH, RAYFEL SCHNEIDER, CARL LASKIN, ALLISON EDDY, DAFNA GLADMAN, MURRAY UROWITZ, DIANE HEBERT, and EARL SILVERMAN
ABSTRACT.
Methods. Sixty-seven patients with onset of lupus nephritis prior to age 18 were identified. The mean followup time was 11 years (range 5-19). The mean age at diagnosis was 13.2 years (range 4-17). The male:female ratio was 1:3.8. Renal biopsies were classified using the WHO classification. Fifteen patients had Class II, 8 patients Class III, 32 patients Class IV, and 11 patients Class V and one patient refused biopsy. The cohort consists of the 66 patients who had a renal biopsy. Five patients received cyclophosphamide (CYC) and 17 received azathioprine (AZA) as part of the initial treatment of Class IV nephritis. Eight additional patients received CYC because of a flare of disease while receiving AZA, and 8 other patients received AZA because of a flare of disease while taking prednisone therapy. Results. Four patients died; 6 developed endstage renal disease (ESRD); all but one of the patients who died and/or had ESRD had WHO Class IV [diffuse proliferative glomerulonephritis (DPGN)]; only 2 Caucasians developed ESRD, although 16 out of 36 Caucasians had DPGN; serum creatinine at followup was normal in 84% of the survivors; presently 70% of the patients take less than 7.5 mg prednisone/day and 62% do not take cytotoxic drugs. No patient is currently treated with CYC. All 8 patients with Class III nephritis were taking medication at last followup. Conclusion. The longterm outcome in this group of children with lupus nephritis, in whom AZA was the most commonly used immunosuppressive agent, was excellent, with 94% patient survival at a mean followup of 11 years. Our results suggest that non-Caucasian patients with pediatric onset lupus nephritis may be at increased risk for renal failure compared to Caucasians. (J Rheumatol 2002;29:2635-42) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS
From the Divisions of Rheumatology and Nephrology, Department of Paediatrics, The Hospital for Sick Children; and the Divisions of Nephrology and Rheumatology, University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. S. Hagelberg, MD, PhD; G. Mah, MD; R. Schneider, MB, BCh, FRCPC; E. Silverman, MD, FRCPC, Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children; Y. Lee, MD, FRCPC; J. Bargman, MD, FRCPC, Division of Nephrology, University Health Network, Department of Medicine, University of Toronto; A. Eddy, MD, current address: Division of Nephrology, Children's Hospital and Regional Medical Center, University of Washington, Seattle, WA, USA; D. Hebert, MD, FRCPC, Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children; C. Laskin, MD; D. Gladman, MD, FRCPC; M. Urowitz, MD, FRCPC, Division of Rheumatology, University Health Network, Department of Medicine, University of Toronto. Address reprint requests to Dr. E. Silverman, Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario M5G 1X8. E-mail: earl.silverman@sickkids.on.ca Submitted December 21, 2001; revision accepted June 11, 2002. |