title: Longterm followup of childhood lupus nephritis.
abstract: OBJECTIVE
  To determine the longterm outcome in children with onset of lupus nephritis before 18 years of age.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Divisions of Rheumatology and Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hagelberg
authors.forename: Yuna
authors.initials: Y
authors.lastname: Lee
authors.forename: Joanne
authors.initials: J
authors.lastname: Bargman
authors.forename: Gordon
authors.initials: G
authors.lastname: Mah
authors.forename: Rayfel
authors.initials: R
authors.lastname: Schneider
authors.forename: Carl
authors.initials: C
authors.lastname: Laskin
authors.forename: Allison
authors.initials: A
authors.lastname: Eddy
authors.forename: Dafna
authors.initials: D
authors.lastname: Gladman
authors.forename: Murray
authors.initials: M
authors.lastname: Urowitz
authors.forename: Diane
authors.initials: D
authors.lastname: Hebert
authors.forename: Earl
authors.initials: E
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001379:Azathioprine / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000473:pathology; D008181:Lupus Nephritis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D001379:Azathioprine