Insights into pediatric lupus nephritis: clinical features and short-term outcomes from a single center retrospective study.

Abstract

Background: Pediatric lupus nephritis is a rare glomerular disease with paucity of data on short and long term outcomes. This single center study aims to assess the outcomes at 12 months and the last follow-up visit.

Methods: This retrospective review of medical charts was done to include children diagnosed with lupus nephritis at Sindh Institute of Urology and Transplantation Karachi from July, 2015 to December, 2022.

Results: Twenty five children included in the analysis had mean age of 11.5 ± 3.5 years with predominant 20 (80%) girls. The most common clinical presentation was nephrotic syndrome in 15 (60%). The means of estimated GFR and serum albumin improved from baseline to 12 months, however serum albumin showed statistically significant improvement (121 ml/min/1.73 m² ± 77 to 130 ml/min/1.73 m² ± 57, -9.2, p-value 0.53 and 2.1 gm/dl ± 0.81 to 3.5 ± 0.73, - 1.4 p-value 0.00). The choice of induction drug had no impact on composite outcome with similar complete remission rates in MMF versus Cyclophosphamide and Calcineurin inhibitors groups (4/10, 40% versus 6/15,40%; p-value 0.81). The failure of complete remission of proteinuria at 12 months was statistically associated with poor composite outcome at last follow-up visit (p-value 0.02).

Conclusion: In our study, the choice of induction regimens had no impact on overall outcome. However, we identified the importance of targeting and reducing proteinuria to improve outcomes in pediatric patients with lupus nephritis.