Acute renal failure in paediatric systemic lupus erythematosus: treatment and outcome.
OBJECTIVE
To determine the outcome of paediatric SLE (pSLE) patients with nephritis who developed acute renal failure (ARF). Efficacy and safety of treatment regimens were compared.


METHODS
A total of 249 pSLE patients were diagnosed and prospectively followed at a single centre between July 1973 and July 2003; 127 children (51%) had lupus nephritis. ARF was defined as serum creatinine of > 250 micromol/l or > 75% above baseline. Standardized assessments included clinical data and medications, laboratory testing, disease activity and damage scores were obtained. Subsequent renal flares were documented.


METHODS
renal function at last follow-up.


RESULTS
treatment efficacy and safety. AZA- and cyclophosphamide (CYCLO)-treated patients were compared. Propensity score methods were applied to balance covariates. An intention to treat approach was chosen.


RESULTS
The ARF study cohort included 50 patients; 13 boys and 37 girls with a median age of 13.2 yrs at diagnosis and a mean follow-up of 45 months. Renal histology: Class III nephritis in 16; Class IV in 34. Dialysis requirement and disease activity were similar in both groups.


METHODS
AZA in 33 patients, CYCLO in 9 and corticosteroids only in 8.


RESULTS
no statistically significant or clinically relevant differences were found for any of the outcome measures including last serum creatinine, time to renal flare, overall renal survival, disease activity over time, disease damage, mean annual corticosteroid dose and rate of infection.


CONCLUSIONS
The treatment of renal failure in this pSLE cohort was associated with an excellent outcome. AZA and CYCLO were equally efficacious.
Benseler
S M
SM
Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario M5G1X8, Canada.
Bargman
J M
JM
Feldman
B M
BM
Tyrrell
P N
PN
Harvey
E
E
Hebert
D
D
Silverman
E D
ED
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001379:Azathioprine / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000503:physiopathology; D008181:Lupus Nephritis / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D001379:Azathioprine