ESPN 51th Annual Meeting

ESPN 2018


 
Effect of the time of onset of pediatric lupus nephritis on its clinical course
HANNA SZYMANIK-GRZELAK 1 ELżBIETA KUźMA-MROCZKOWSKA MAłGORZATA PAńCZYK-TOMASZEWSKA 1 MAłGORZATA BARABASZ 2 IRENA WIKIERA-MAGOTT 3 BEATA BANASZAK 4 ANNA WIECZORKIEWICZ-PłAZA 5 BEATA BIENIAś 5 MAGDALENA DROżYNSKA-DUKLAS 6 Marcin Tkaczyk 1

1- Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland
2- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical Sciences, Poznan, Poland
3- Department of Pediatric Nephrology, Wroclaw Medical University, Poland
4- Department of Pediatrics, SMDZ in Zabrze, Silesian Medical University, Katowice, Poland
5- Department of Pediatric Nephrology, Medical University of Lublin, Poland
6- Department of Pediatric Nephrology, Medical University of Gdansk, Gdansk, Poland
 
Introduction:

Systemic lupus erythematosus (SLE) has a higher incidence of renal involvement in children than in adults. The aim of the study was to evaluate symptoms of SLE in children with the diagnosis of lupus nephritis (LN) in relation to the time of onset of nephropathy.

Material and methods:

We report 39 patients (32 girls,7 boys) with SLE diagnosed at mean age 13,48± 3,32 years. Early LN (e-LN) was defined as the development of LN manifestations within 0-1 month, and delayed LN (d-LN) was defined as LN presentation >1 month after the onset of SLE.

Results:

Most common symptoms of SLE were cutaneous lesions (84%), joint involvement (71%), neuropsychiatric symptoms (46%) and leukopenia (82%). e-LN was diagnosed in 38.5%; d-LN in 61.5% of children after 4.57±10,0 months from SLE onset. The mean severity of renal manifestations as evaluated using the SLE Disease Activity Index (SLEDAI) score was 10.15±2.73 points and was similar in both groups. In e-LN higher proteinuria (5.21± 4.95 vs 2.7± 2.57 g/day), lower albumin levels (3.0±0.99 vs 3.51±61 g/dL), more severe leukopenia (4.59±2.51 vs 5.46±4.7x103/mL) and more severe anemia (9.9 ±1.34 vs 10.36±2.0 g/dL) were found. In d-LN the mean GFR was lower than in e-LN (70.22±40.1 vs 76.27± 28.8 mL/min/1.73 m2), so as C3 (42.55±19.9 vs 60.7±36.3 mg/dL) and C4 (10.1±8.65 vs 14.5±11.03 mg/dL). Kidney biopsy showed proliferative forms of LN regardless of the time of onset of nephropathy.

Conclusions:

Lupus nephritis most commonly develops within one year after the onset of pediatric SLE. Early LN in children is characterized by more severe proteinuria, leukopenia, and anemia, while the mean GFR and C3 and C4 complement component levels are lower in delayed LN. Proliferative forms of LN in children may have a varying clinical presentation independent of the time of onset of nephropathy.