Predictors of Relapse and End Stage Kidney Disease in Proliferative Lupus Nephritis: Focus on Children, Adolescents, and Young Adults

Predictors of Relapse and End Stage Kidney Disease in Proliferative Lupus Nephritis: Focus on Children, Adolescents, and Young Adults

The prevalence and significance of remission and relapse in children, adolescents, and young adults with lupus nephritis in the United States are poorly understood. Patterns and predictors of disease progression in a southeastern U.S. pediatric cohort with severe lupus nephritis are presented. Indiv...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology Vol. 4; no. 12; pp. 1962 - 1967
Main Authors: Gibson, Keisha L, Gipson, Debbie S, Massengill, Susan A, Dooley, Mary Anne, Primack, William A, Ferris, Maria A, Hogan, Susan L
Format: Journal Article
Language:English
Published: United States American Society of Nephrology 01-12-2009
Series:Original Articles
Subjects:
Adolescent
Biopsy
Child
Disease Progression
Female
Follow-Up Studies
Humans
Kidney - pathology
Kidney Failure, Chronic - epidemiology
Kidney Failure, Chronic - prevention & control
Lupus Nephritis - epidemiology
Lupus Nephritis - pathology
Lupus Nephritis - therapy
Male
Original
Predictive Value of Tests
Prevalence
Proportional Hazards Models
Recurrence
Remission Induction
Risk Factors
United States - epidemiology
Young Adult
United States
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Summary:The prevalence and significance of remission and relapse in children, adolescents, and young adults with lupus nephritis in the United States are poorly understood. Patterns and predictors of disease progression in a southeastern U.S. pediatric cohort with severe lupus nephritis are presented. Individuals age 21 or less with kidney biopsy-proven lupus nephritis followed in the Glomerular Disease Collaborative Network were included. Cox regression models were used to evaluate predictors of relapse and end stage kidney disease (ESKD). Seventy-three subjects with a mean age of 15.6 +/- 3.4 yr were included. Five-year kidney survival was 77%. Complete and partial remission rates within 1 yr of induction therapy were 25 and 64%, respectively. Relapse and ESKD rates were similar between complete and partial responders. Relapse occurred in 35% of responders (complete or partial) in 45 +/- 32 mo. Disease relapse was a predictor of ESKD (HR = 10.12, P < 0.0001). Treatment resistance was documented in African Americans more often than non-African Americans (eight versus 0; P = 0.03). ESKD HR associated with treatment resistance was 6.25, P < 0.002. Remission whether complete or partial is associated with improved kidney survival in children with lupus nephritis. Nephritis relapse is a strong predictor of progression to ESKD. Treatment resistance portends a high risk of ESKD and disproportionately affects African American children with lupus nephritis.
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ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.00490109