title: Lupus nephritis is more severe in children and adolescents than in older adults.
abstract: OBJECTIVE
  To evaluate clinicopathological features and treatment response in patients with lupus nephritis (LN), comparing the childhood- and late-onset forms of the disease.
  
  
  METHODS
  We retrospectively analyzed clinical presentation, treatment and evolution in patients diagnosed with LN by renal biopsy between 1999 and 2008. Patients were grouped by age-≤18 years (n = 23); and ≥50 years (n = 13)-and were followed for the first year of treatment.
  
  
  RESULTS
  The baseline features of the childhood- and late-onset groups, respectively, were as follows: mean age, 15 ± 2 and 54 ± 5 years; female gender, 87% and 92%; hypertension, 87% and 77%; Systemic Lupus Erythematosus Disease Activity Index, 29 ± 9 and 17 ± 7 (p = 0.002); estimated glomerular filtration rate (eGFR), 86 ± 66 and 70 ± 18 ml/min; concurrent SLE/LN diagnosis, 90% and 15% (p < 0.001); crescents on biopsy, 74% and 30% (p = 0.02); activity index on biopsy, 4.8 ± 2.6 and 3.3 ± 1.9 (p = 0.10); and interstitial fibrosis (>10%), 39% and 61% (p = 0.08). Treatment consisted mainly of methylprednisolone, prednisone and intravenous cyclophosphamide, average cumulative doses being similar between the groups. After 12 months of treatment, the eGFR in the younger and older patients was 116 ± 62 and 78 ± 20 ml/min, respectively (p = 0.005). Three of the younger patients progressed to dialysis at 12 months, compared with none of the older patients.
  
  
  CONCLUSIONS
  Childhood-onset LN seems to be more severe than is late-onset LN.
authors.affiliation: Nephrology Division, University of São Paulo, School of Medicine, São Paulo, Brazil. victorhsato@yahoo.com.br
authors.forename: V A H
authors.initials: VA
authors.lastname: Sato
authors.forename: I D B
authors.initials: ID
authors.lastname: Marques
authors.forename: P T
authors.initials: PT
authors.lastname: Goldenstein
authors.forename: L P F
authors.initials: LP
authors.lastname: Carmo
authors.forename: L B
authors.initials: LB
authors.lastname: Jorge
authors.forename: S M O
authors.initials: SM
authors.lastname: Titan
authors.forename: R T
authors.initials: RT
authors.lastname: Barros
authors.forename: V
authors.initials: V
authors.lastname: Woronik
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001706:Biopsy; D002648:Child; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000473:pathology; D008181:Lupus Nephritis / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents