title: Early predictors of outcomes in pediatric lupus nephritis: focus on proliferative lesions.
abstract: OBJECTIVE
  Studies regarding the clinical features and outcomes of pediatric lupus nephritis are limited, and risk factors of poor outcome in the more severe form of renal involvement, proliferative lupus nephritis (PLN), are poorly understood. This study analyzed the data from a large prospective cohort of childhood systemic lupus erythematosus to determine such risk factors.
  
  
  METHODS
  Subjects younger than 18 years at onset with biopsy-proven lupus nephritis were enrolled. Data on baseline presentations and laboratory values, response to treatment, and outcomes were collected. Primary outcome measures were death or end-stage renal disease (ESRD). Survival analysis was done and predictors were approached.
  
  
  RESULTS
  One hundred four patients with mean age of 12.4 ± 2.5 years (range, 4.0-17.2 years) and the female-to-male ratio of 5.94:1 were included. Among them, 81 patients had PLN and 23 had non-proliferative lupus nephritis. Those with PLN had significantly lower GFR, more proteinuria, more urine sediment, more hypertension, and poor early response to treatment (within 6 months). There was no significant difference in extra-renal manifestations. All poor outcomes happened in the PLN group. The prognostic factors were high baseline SLEDAI-2k >20 (HR, 6.76; p = 0.002), baseline GFR <60ml/min/m² (HR, 3.88; p = 0.022), and early responder (HR, 0.19; p = 0.013).
  
  
  CONCLUSIONS
  Patients with pediatric lupus nephritis and high risk factor can be identified early by concomitantly considering their baseline features and early response, which provides a novel hint in decision for management decisions.
authors: Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, 5, Fu-Hsin St, Taoyuan, Taiwan.
authors: Jhong-Yong
authors: JY
authors: Wu
authors: Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, 5, Fu-Hsin St, Taoyuan, Taiwan.
authors: Kuo-Wei
authors: KW
authors: Yeh
authors: Department of Pediatrics, Division of Allergy, Asthma and Rheumatology, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, 5, Fu-Hsin St, Taoyuan, Taiwan. Electronic address: long@adm.cgmh.org.tw.
authors: Jing-Long
authors: JL
authors: Huang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Children; Lupus nephritis; Outcomes; Predictors