title: Childhood lupus nephritis in a developing country-24 years' single-center experience from North India.
abstract: OBJECTIVE
  Data on outcome of childhood lupus nephritis from developing countries are sparse. This study looks at outcome in children with lupus nephritis from a federal government-funded teaching hospital in North India.
  
  
  METHODS
  This study included children less than 14 years of age with lupus nephritis who presented to a single center during a period of 24 years (1991 to 2013). Data on clinical characteristics and outcome were extracted from medical records. The primary outcome was actuarial survival (time-to-death) and secondary outcome was actuarial renal survival using Kaplan-Meier analysis. A worst-case scenario that assumed children who were lost to follow-up as having either died or gone into end-stage renal disease was also calculated. Log-rank test and Cox-regression were used to assess difference in survival by histological class and predictors of poor outcome, respectively.
  
  
  RESULTS
  This study included 72 children, with a female:male ratio of 3:1, mean (±SD) age at onset of lupus 9.3 (±2.4) years and mean (±SD) time from onset-to-nephritis being 9.4 (±12.6) months. Renal biopsy was conducted in 53 children. The most common histological class was class IV (35 children). Mortality occurred in 22 children (30%), with half of these occurring at presentation. The two important causes of death were infection and end-stage renal disease. Actuarial survival was 81%, 67% and 59% at one, five and 10 years, respectively. In the worst-case scenario, actuarial survival was 72%, 53% and 38%, respectively. Renal survival was 96%, 89% and 78% (worst-case scenario 86%, 73% and 52%) at one, five and 10 years, respectively. There was no difference in survival by histological class. On univariate analysis, serum creatinine at presentation (hazard ratio = 2.2 (95% CI 1.3-3.9)) and serious infection (hazard ratio 7.9 (95% CI 2.6-23.5)) were statistically significant predictors of time-to-death.
  
  
  CONCLUSIONS
  Outcome of children with lupus nephritis from India is worse than developed countries. Nearly one-third of the children died, half at presentation, with common causes being infection and end-stage renal disease.
authors.affiliation: Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre surjitsinghpgi@rediffmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.affiliation: Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre.
authors.forename: B
authors.initials: B
authors.lastname: Abujam
authors.affiliation: Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre.
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre.
authors.forename: D
authors.initials: D
authors.lastname: Suri
authors.affiliation: Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre.
authors.forename: A
authors.initials: A
authors.lastname: Rawat
authors.affiliation: Department of Immunopathology.
authors.forename: B
authors.initials: B
authors.lastname: Saikia
authors.affiliation: Department of Immunopathology.
authors.forename: R Walker
authors.initials: RW
authors.lastname: Minz
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: K
authors.initials: K
authors.lastname: Joshi
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: R
authors.initials: R
authors.lastname: Nada
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D003906:Developing Countries; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008181:Lupus Nephritis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents
keywords: Childhood systemic lupus erythematosus; disease activity; lupus nephritis