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Observational Study
. 2023 Jun;38(6):1843-1854.
doi: 10.1007/s00467-022-05811-y. Epub 2022 Nov 21.

Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus

Ana P Sakamoto  1 , Clovis A Silva  2 , Aline G Islabão  3 , Glaucia V Novak  2 , Beatriz Molinari  2 , Paulo K Nogueira  4 , Rosa M R Pereira  5 , Claudia Saad-Magalhães  6 , Gleice Clemente  7 , Daniela P Piotto  7 , Nadia E Aikawa  5 , Ana C Pitta  2 , Vitor C Trindade  2 , Simone Appenzeller  8 , Luciana M Carvalho  9 , Carlos N Rabelo-Junior  10 , Adriana R Fonseca  11 , Flavio R Sztajnbok  12 , Maria C Santos  13 , Blanca E Bica  14 , Evaldo G Sena  15 , Ana J Moraes  16 , Melissa M Fraga  17 , Teresa C Robazzi  18 , Paulo F Spelling  19 , Iloite M Scheibel  20 , Andre S Cavalcanti  21 , Erica N Matos  22 , Luciano J Guimarães  23 , Flavia P Santos  24 , Licia M H Mota  25 , Eloisa Bonfá  5 , Maria T Terreri  7 ; Brazilian Childhood-onset Systemic Lupus Erythematosus Registry Group
Affiliations
Observational Study

Chronic kidney disease in patients with childhood-onset systemic lupus erythematosus

Ana P Sakamoto et al. Pediatr Nephrol. 2023 Jun.

Abstract

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.

Keywords: Adolescent; Childhood; Childhood-onset systemic lupus erythematosus; Chronic kidney disease; Lupus nephritis; Systemic lupus erythematosus.

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References

    1. Tarr T, Dérfalvi B, Györi N, Szántó A, Siminszky Z, Malik A, Szabó AJ, Zeher M (2015) Similarities and differences between pediatric and adult patients with systemic lupus erythematosus. Lupus 24:796–803. https://doi.org/10.1177/0961203314563817 - DOI - PubMed
    1. Silva CA, Avcin T, Brunner HI (2012) Taxonomy for systemic lupus erythematosus with onset before adulthood. Arthritis Care Res (Hoboken) 64:1787–1793. https://doi.org/10.1002/acr.21757 - DOI - PubMed
    1. Smith EMD, Lythgoe H, Midgley A, Beresford MW, Hedrich CM (2019) Juvenile-onset systemic lupus erythematosus: update on clinical presentation, pathophysiology and treatment options. Clin Immunol 209:108274. https://doi.org/10.1016/j.clim.2019.108274 - DOI - PubMed
    1. Tektonidou MG, Lewandowski LB, Hu J, Dasgupta A, Ward MM (2017) Survival in adults and children with systemic lupus erythematosus: a systematic review and Bayesian meta-analysis of studies from 1950 to 2016. Ann Rheum Dis 76:2009–2016. https://doi.org/10.1136/annrheumdis-2017-211663 - DOI - PubMed
    1. Anders HJ, Saxena R, Zhao M, Parodis I, Salmon JE, Mohan C (2020) Lupus nephritis. Nat Rev Dis Primers 6:7. https://doi.org/10.1038/s41572-019-0141-9 - DOI - PubMed

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