Diffuse proliferative glomerulonephritis does not determine the worst outcome in childhood-onset lupus nephritis: a 23-year experience in a single centre.
BACKGROUND
Lupus nephritis (LN) is the major indicator of morbidity and mortality in systemic lupus erythematosus (SLE). Many studies have found a significantly worse patient survival rate in patients with LN class IV than patients with other LN classes.


OBJECTIVE
The aim was to describe the severity and outcomes of LN in a group of Thai children.


METHODS
We retrospectively reviewed the patient files of children diagnosed with SLE aged < or =18 years in Songklanagarind Hospital, Southern Thailand, from 1985 to 2007.


RESULTS
Of 216 SLE patients, 180 had renal biopsy results, and the others were excluded from analysis. There were 33 males and 147 females, average age 11.8 +/- 2.6 years (range 3.6-18.0), with a median follow-up period of 3.9 years (range 9 days to 19.4 years). Using the WHO LN classification, there were 9, 55, 5, 94 and 14 patients of classes I-V, respectively, as well as 2 with end-stage renal disease and 1 with IgM nephropathy. The mortality rate was 23% (42/180). Patients with LN class II had a similar renal and patient survival compared to patients with LN class IV (P = 0.3 and 0.2, respectively). Cox proportional hazard regression analysis in 177 patients (3 patients who had a renal biopsy result outside the WHO classification were omitted) showed that gender was an independent risk factor for survival. Males had 2.6 times the hazard rate compared to females (95% CI 1.2-5.7, P = 0.03), but LN classification, age and timing of the renal biopsy were not significant.


CONCLUSIONS
Renal and patient survival in LN classes II and IV were similar. Gender was the only independent risk factor of mortality, with males at greater risk than females.
Vachvanichsanong
Prayong
P
Department of Pediatrics, Prince of Songkla University, Hat Yai, Thailand. vprayong@msn.com
Dissaneewate
Pornsak
P
McNeil
Edward
E
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology; D008181:Lupus Nephritis / Q000145:classification / Q000401:mortality* / Q000473:pathology*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D013785:Thailand / Q000453:epidemiology