Glomerulonephritis in children with mixed connective tissue disease.
OBJECTIVE
Mixed connective tissue disease (MCTD) has overlapping clinical features with systemic lupus erythematosus (SLE). Renal biopsy is necessary for all children with SLE to evaluate the prognosis, because they are at a quite high risk of developing renal complications. Furthermore, lupus nephritis and hypocomplementemia usually precede the appearance of clinical manifestations. Immune complex-mediated nephritis is one of the major complications of MCTD. Juvenile MCTD is known to be associated with a higher risk of nephritis than adult MCTD. However, it is uncertain whether all children with MCTD should be subjected to a renal biopsy, and whether most of those with hypocomplementemia present nephropathy, as in patients with SLE. We examined the histopathological characteristics of juvenile MCTD nephritis, the importance of renal biopsy and the implications of hypocomplementemia in our patients and reported cases of MCTD.


METHODS
We performed renal biopsy in 11 children with MCTD and found 6 patients with glomerulonephritis. In addition, we studied the frequency and the characteristics of glomerulonephritis in 71 cases of juvenile MCTD (our 11 patients and 60 reported cases). We also analyzed the relationship between hypocomplementemia and pathological features in 41 cases of MCTD nephritis (23 adults, 18 children).


RESULTS
6 of our 11 patients had glomerulonephritis, but of them four had no abnormality in urinalysis at the time of biopsy. In 5 patients renal biopsy showed normal findings. Review of 71 cases of juvenile MCTD showed that of them 28% presented latent asymptomatic nephritis at the time of biopsy. Membranous nephropathy (MN) and mesangial proliferative glomerulonephritis (MPG) were common in MCTD. Interestingly, hypocomplementemia was more frequently observed in patients with MN or mixed form of MN and MPG (MPG/MN) than simple MPG based on our review of 41 cases (p < 0.01).


CONCLUSIONS
A more aggressive indication of renal biopsy should be considered in children with MCTD because of the high incidence of non-clinical nephritis. The hypocomplementemia observed in patients with MCTD suggests the high frequency of glomerulonephritis, including membranous lesions.
Ito
S
S
Department of Pediatrics, Yokohama City University Medical Center, Urafunecho 4-57, Minamiku, Yokohama, Kanagawa, 232-0024 Japan. hi5-si@urahp.yokohama-cu.ac.jp
Nakamura
T
T
Kurosawa
R
R
Miyamae
T
T
Imagawa
T
T
Mori
M
M
Aihara
Y
Y
Yokota
S
S
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications* / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D008947:Mixed Connective Tissue Disease / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D011379:Prognosis