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Twelve-month outcome in juvenile proliferative lupus nephritis: results of the German registry study.
- Source :
-
Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2020 Jul; Vol. 35 (7), pp. 1235-1246. Date of Electronic Publication: 2020 Mar 19. - Publication Year :
- 2020
-
Abstract
- Background: Children presenting with proliferative lupus nephritis (LN) are treated with intensified immunosuppressive protocols. Data on renal outcome and treatment toxicity is scare.<br />Methods: Twelve-month renal outcome and comorbidity were assessed in 79 predominantly Caucasian children with proliferative LN reported to the Lupus Nephritis Registry of the German Society of Paediatric Nephrology diagnosed between 1997 and 2015.<br />Results: At the time of diagnosis, median age was 13.7 (interquartile range 11.8-15.8) years; 86% showed WHO histology class IV, nephrotic range proteinuria was noted in 55%, and median estimated glomerular filtration rate amounted to 75 ml/min/1.73 m <superscript>2</superscript> . At 12 months, the percentage of patients with complete and partial remission was 38% and 41%, respectively. Six percent of patients were non-responders and 15% presented with renal flare. Nephrotic range proteinuria at the time of diagnosis was associated with inferior renal outcome (odds ratio 5.34, 95% confidence interval 1.26-22.62, p = 0.02), whereas all other variables including mode of immune-suppressive treatment (e.g., induction treatment with cyclophosphamide (IVCYC) versus mycophenolate mofetil (MMF)) were not significant correlates. Complications were reported in 80% of patients including glucocorticoid toxicity in 42% (Cushingoid appearance, striae distensae, cataract, or osteonecrosis), leukopenia in 37%, infection in 23%, and menstrual disorder in 20%. Growth impairment, more pronounced in boys than girls, was noted in 78% of patients.<br />Conclusions: In this cohort of juvenile proliferative LN, renal outcome at 12 months was good irrespectively if patients received induction treatment with MMF or IVCYC, but glucocorticoid toxicity was very high underscoring the need for corticoid sparing protocols. Graphical abstract.
- Subjects :
- Adolescent
Child
Cyclophosphamide adverse effects
Enzyme Inhibitors adverse effects
Female
Germany
Glucocorticoids adverse effects
Humans
Immunosuppressive Agents adverse effects
Male
Mycophenolic Acid adverse effects
Prospective Studies
Registries
Remission Induction
Retrospective Studies
Treatment Outcome
Cyclophosphamide administration & dosage
Enzyme Inhibitors administration & dosage
Immunosuppressive Agents administration & dosage
Lupus Nephritis drug therapy
Mycophenolic Acid administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1432-198X
- Volume :
- 35
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Pediatric nephrology (Berlin, Germany)
- Publication Type :
- Academic Journal
- Accession number :
- 32193650
- Full Text :
- https://doi.org/10.1007/s00467-020-04501-x